Transcript Request
A signed consent for graduated students record release is required before transcripts can be released to former Berkshire and Ledgemont High Schools graduates, colleges, military, employers, recruiters, etc. Please complete all sections of this form and a representative from Berkshire Local School District will be in contact with you.
Date of Request: *
Graduation Year: *
Graduate of: *
Last Name: *
First Name: *
Middle Name *
Maiden Name or Name while attending Berkshire/Ledgemont: *
Current Address: *
City, State and Zip Code: *
Date of Birth: *
Phone Number, Including Area Code (XXX-XXX-XXXX): *
E-mail Address: *
I hereby authorize release of my transcript to:
Please provide Name and Address of: College, Employer, Military, etc. or check SELF, if to be mailed to the address listed above: If mailed to "SELF" the transcript will be an unofficial copy.
Clear selection
Name of College, Employer, Military, Self, etc.
City, State, Zip Code
By entering your initials in the box below, you are effectively providing your signature, and indicating that all the information on this form is true and accurate, to the best of your knowledge.
Initial Here: *
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