Eastern Regional High School Release Request (former students)

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Request for Immunization/New Diploma/Transcript

Email *

Record my email address with my response

Ref. New Jersey Administrative Code #6:3-6.1 et seq. states, “Organizations, agencies and persons from outside the school shall have access to pupil records if they have written consent of parent or adult pupil (age 18)”.

I have read the above statement and, pursuant to the law - I hereby authorize the release of the transcript (school records) concerning the student named below, to the following outside agencies, colleges, employers, etc. that bear my electronic signature/signature. By selecting the "I Accept" button, you are signing this Agreement electronically.

I Accept

Required

Full Legal Name (Please include your first, middle, last names, and maiden name, if applicable) *

Date of Birth *

YYYY

Graduation Year/Last Year Attended *

YYYY

Your Email Address *

Your Home/Mobile Number *

REQUESTS

If you are requesting an official transcript, the transcript must be emailed or mailed directly to the agency, college, employer, military, university, etc.

If you need an unofficial transcript for personal use, it can be emailed or mailed to you.

New Diploma (Please allow 14 days)

Immunization Record (Please allow 14 days)

Transcript (Please allow 14 days)

Required

Please provide the email address of the college or company that the transcript and/or immunization record is being sent. *

Please provide a mailing (home) address for the diploma request.

Electronic Signature

Under 18 - Legal Guardian/Parent
Over 18 - Former Student

Send me a copy of my responses.

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