Transcript Request Form

Required

South River High School

Department of Student Services

11 Montgomery Street, South River, NJ 08882

PHONE (732) 613-4014 x6229 | FAX (732) 613-4044

REQUEST FOR TRANSCRIPT - FORMER STUDENTS

PLEASE ALLOW TEN (10) BUSINESS DAYS TO PROCESS APPLICATIONS

Namerequired

First Name

Last Name

Name at Graduation/ Withdrawal (if different)

Date of Birthrequired

Must contain a date in M/D/YYYY format

Date of Graduation/Withdrawalrequired

Must contain a date in M/D/YYYY format

Current Home Addressrequired

Current Phone Numberrequired

Date Neededrequired

Must contain a date in M/D/YYYY format

I would like an UNOFFICIAL TRANSCRIPT for my personal use to be sent to the above home address.

I would like an OFFICIAL TRANSCRIPT to be sent to the following address - please be sure to include the complete address.

Enter address(es) for receiving institution(s) here:required

I understand that I have the option to delete from such release any disciplinary records maintained by the school district. I choose to delete the following disciplinary records from this release:

I, the undersigned, acknowledge and approve the release of pertinent school records to the institution(s) indicated above.

Signature (please type full name) (Or Parent/Guardian if under 18)required

South River High School

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