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: *
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Graduation Year: *
Your answer
Graduate of: *
Last Name: *
Your answer
First Name: *
Your answer
Middle Name *
Your answer
Maiden Name or Name while attending Berkshire/Ledgemont: *
Your answer
Current Address: *
Your answer
City, State and Zip Code: *
Your answer
Date of Birth: *
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Phone Number, Including Area Code (XXX-XXX-XXXX): *
Your answer
E-mail Address: *
Your answer
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.
SELF?
Name of College, Employer, Military, Self, etc.
Your answer
Address
Your answer
City, State, Zip Code
Your answer
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: *
Your answer
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