HARRISON COMMUNITY HIGH SCHOOL

TRANSCRIPT RELEASE CONSENT FORM

In accordance with the provisions of the Family Educational Rights and Privacy Act of 1974, I request that transcripts of:
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               NAME (please print)		   _________________________________
             BIRTHDATE


To be forwarded to:

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INSTITUTION		 ________________________________
ADDRESS		 _________________
CITY		 ________
STATE		 __________
ZIP

 

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PARENT/GUARDIAN SIGNATURE		  

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DATE
     
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STUDENT SIGNATURE IF 18 OR OLDER		  

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DATE