Transcript/Immunization Request Form-For Outside Investigative Agencies Only
King George County School Board Office
P.O. Box 1239
King George, VA 22485
Att: Cassandra Norris, Medicaid and School Records Manager
540-775-5833 ex.8619 Office
540-775-2165 Fax
cnorris@kgcs.k12.va.us

Please provide the following information in order to obtain a copy of your transcript.
Please fax a copy of the student release form for identification.

Please allow 7-10 business days to process.
Email address *
Name of Requesting Agency *
Your answer
Date *
MM
/
DD
/
YYYY
Student First Name *
Your answer
Student Last Name *
Your answer
Student Maiden Name
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Student Graduation Year *
Your answer
Student Withdrawal Year *
Your answer
Are you requesting a transcript or immunizations record? *
Required
Requesting Agency's Current Telephone (Provide a current telephone number where you can be reached) *
Your answer
Requesting Agency's Current Email (Provide a current email address) *
Your answer
How would you like to access your record(s)? *
Required
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