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RECORDS REQUEST FORM
THIS FORM MUST BE COMPLETED BY THE FORMER STUDENT ONLY. RECORD REQUESTS ARE PROCESSED AS QUICKLY AS POSSIBLE. DUE TO THE LOCATION OF FILES, IT MAY TAKE UP TO TWO WEEKS FOR US TO PROCESS. PLEASE PLAN ACCORDINGLY.
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Email
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Your email
RECORD NEEDED (PLEASE CHECK)
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TRANSCRIPT
IMMUNIZATON RECORD
OTHER
Required
Name at time of Graduation (Maiden Name,etc.)
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Your answer
Year of Graduation/Year left School:
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Daytime Phone Number:
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Your answer
I Authorize Averill Park High School to send my records to:
Please choose ONE of the following forms of delivery. Please include all information needed to be able to send
I authorize Averill Park High School to MAIL my records to:
Your answer
I authorize Averill Park High School to EMAIL my records to the following institution at the following email address:
Your answer
I authorize Averill Park High School to Fax my records to the following institution at Fax number:
Your answer
I would like to make arrangements to pick up my transcript.
Option 1- I will pick up my transcript in person.
By completing and submitting this form, you are confirming that you are the above-named person and you are agreeing to the terms and conditions allowing APCSD to release your records to the institution indicated on the form.
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By checking this box, I agree that I am electronically signing this form
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A copy of your responses will be emailed to the address you provided.
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