Transcript Records Request Form by cpd16778

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									                                                Transcript / Records
                                                   Request Form
                                     Type of information needed: (Please Check)
                                     _____ OFFICIAL TRANSCRIPT
                                           2000 & Before - $4.00 Each
    There is a cost to process
                                           2001 & After - $3.00 Each
      this request which is                Faxed copies - $5.00 Add’l
        determined by the
      T.C.A.P.S. Business            _____ IMMUNIZATION RECORDS - $4.00
     Office. Included in this
      charge is postage for
                                     _____ OTHER (IEP REPORTS, ETC)
       domestic U.S. only.           Mail request & check (payable to TCAPS) to:
                                     TC West Senior High
                                     5376 North Long Lake Road
                                     Traverse City, MI 49684


LAST NAME:_____________________ FIRST:______________________ MIDDLE: ___________
MAIDEN NAME: ____________________ (IF APPLICABLE)                            TELEPHONE: (____)_____________
DATE OF BIRTH: _____/_____/______                       YEAR GRADUATED OR LAST ATTENED: __________



SEND REQUESTED INFORMATION TO:


1) ___________________________________                        2)___________________________________
  ___________________________________                            ___________________________________
  ___________________________________                            ___________________________________
  ___________________________________                            ___________________________________



SIGNATURE: __________________________________                                    DATE: __________________




                                                  OFFICE USE ONLY

    Date Received                                                                                    By:
    Date Sent                                                                                        By:
    Amount Received                                                                                  By:

   Per Copy Rates 06/07: Transcripts before 2002 - $4.00 / 2002 and after $3.00; Immunizations / $4.00; CA60 $4.00 plus .25
   per page

								
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