Galesburg High School Consent for Release of School Records
I hereby consent to the release of the following information from the school student records of:
Name (Last, First) *
Please also provide a different last name if it was used when you attended.
Your answer
Year of Graduation *
Your answer
Date of birth *
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Your answer
Purpose of sending this transcript *
Please release the above information to the following person/college: *
Please include name and full address
Your answer
The fee to send transcripts at Galesburg High School is three transcripts for $1.00. Payment may be made in person at Galesburg High School, or a check may be sent via mail. Contact Mrs. Stephan at (309) 973-2258 with any questions or if you need assistance. *
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