Headwaters Records & Transcript Request Form

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Complete this form to have records sent to yourself or another institution. Current and former students must not have outstanding balances with our accounting department for your request to be fulfilled. If you would like to check on or resolve your account status please email accounting@headwaters.org.

You will receive an email confirmation that your transcript has been prepared and is ready for pick-up or is in the mail.

If you have any questions, please reach out to registrar@headwaters.org.

Email *

Phone Number *

Student Full Name (when at Headwaters) *

Graduation year *

Records Requesting *

Please select all that apply.

Official Transcript to be mailed or emailed to another institution

Official Transcript to be mailed to you

Official Transcript to be picked up at our downtown campus

Select this option to have an unofficial transcript emailed to you in pdf form

Other records such as medical, immunization records, standardized test results (list in comments)

Required

Name and Full Mailing Address/Email Address of institution or person records to be sent to: *

Please include name, address, city, state, zip. Enter "N/A" if requesting an emailed unofficial pdf.

Optional Additional Address(es)

If you would like a transcript sent to additional institutions please list the institution name(s) and complete addresses or email addresses here (name, address, city, state, zip). If the information is not complete the records may not reach your desired location. Also please specify here if you are requesting records other than a transcript.

Comments

A copy of your responses will be emailed to the address you provided.

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