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Transcript Request Form
Central Valley High School
Gateway Unified School District
Telephone: (530) 275-7075 Ext. 4007
Fax: (530) 275-7065
Email: dtweedy@gatewayusd.org

It has been interpreted, that in compliance with the Federal Family Education Rights and Privacy Act of 1976, (H.R. 69), a school district must have written consent from a parent or guardian before any public school record may be release from a district. Therefore, please complete the following:
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Email *
Name of person completing this form *
Relationship to the student *
Student's legal last name when they attended Central Valley High School *
Student's date of birth

 *
MM
/
DD
/
YYYY
Which applies to the student?  *
Year of graduation or last year of attendance *
Type of transcript needed *
Where would you like the transcript sent?
Name of College/University, Employer and/or self
 *
Address or Email for College/University, Employer and/or Self
 *
Your phone # in case we need to contact you *
Notes to Registrar regarding transcripts
Electronic Signature: Type your Full Name (please note that by submitting your electronic signature, you are authorizing Central Valley High School to release your transcript) *
 *
Submit
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