ELYRIA CATHOLIC HIGH SCHOOL Transcript Request Form for Grades

							                 ELYRIA CATHOLIC HIGH SCHOOL
             Transcript Request Form for Grades 9, 10 and 11
                                                        ________________________
                                                                    DATE
                                                        ________________________
                                                            YEAR OF GRADUATION
                                                        ____________________________
                                                              DATE OF BIRTH

I give permission for the records and standardized scores of:
                                   _________________________________________
                                                        NAME
                                   __________________________________________
                                                      ADDRESS
to be sent to:_____________________________________________________________
            _____________________________________________________________
            _____________________________________________________________
                                               ________________________________
                                                           SIGNATURE
                                               ________________________________
                                                 RELATION OF ABOVE TO STUDENT
Date Mailed ___________________
$3.00 Fee Paid ______   Cash______     Check # ______