RECORDS REQUEST FORM

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Please complete the form below and it will be submitted to the Counseling Office.
Should you require additional assistance please call 330-877-4285 and ask for Tanya Reynolds or Pam Black.

Email *

Name *

Maiden Name *

Date of Birth *

YYYY

Graduation Year *

If you did not graduate what year did you withdraw from Lake High School

Address *

Phone Number *

Records Needed *

Official Transcript - Official transcripts CANNOT be opened

Unofficial Transcript

Health Records - i.e. shot records

IEP/ETR

Required

Preferred delivery method for your transcript and/or records request *

Fax

Mail

Where to send records to(choose all that apply): *

University/College

Education Verification for Employment

Pick-up

Email-(Will be unofficial)

Fax-(Will be unofficial)

Required

Based on the selection above, please provide the name, address, email or fax number. If multiple selected above, please label each(Ex. If University and email selected above it should look like this: The Ohio State University-281 W. Lane Ave. Columbus, OH 43210, and please also email to johnsmith@gmail.com). *

Submit

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