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Transcript Request

Please complete the form below. Required fields marked with an asterisk *

Student Information

First Name*

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Middle Name

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Last Name*

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Former name used at time of enrollment (if applicable)

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Email Address*

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Phone Number

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Social Security Number*

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Current or last grade attended*

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Current or last year attended*

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Year of high school graduation (if applicable)

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Transcript Information

I am requesting a transcript and would like the transcript to be delivered via the following method:*

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Emailed

Faxed

Mailed

If you would like a transcript to be emailed, please provide a preferred email address:

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If you would like a transcript to be faxed, please provide a fax number:

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If you would like a transcript to be mailed, please provide a preferred mailing address:

Name of Individual, School, Business, or Organization:

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Address

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City

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State

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Zip Code

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Requester Information

Authorization to release records: I authorize NYOS Charter School to release the information above in the manner in which I have requested. * FERPA (Family Educational Rights and Privacy Act) is a federal law that gives parents the right to have access their child's student records. When a student turns 18 years old or enters a post-secondary institution, FERPA rights are transferred from the parent/guardian to the student. *

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Yes

Requestor's Full Name*

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Requestor's Phone Number (if different from above)

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Requestor's Email Address (if different from above)

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Requestor's relationship to student

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Self

Parent/Guardian

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Confirmation

Signature*

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Date*

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Confirmation Email

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