Three Rivers Academy
Transcript Request Form
DO NOT RETURN THIS FORM WITH THE APPLICATION. It is to be mailed or delivered to your child’s current school.
MAIL OR DELIVER TO: Principal or Counselor at Current School
Name of Current School
_____________________________________
Address of Current School
_____________________________________
City, State and Zip
_____________________________________
Applicant’s Legal Name (PLEASE PRINT OR TYPE):
Last
_____________________________________
First
_____________________________________
Middle Initial
_____________________________________
Applicant’s Social Security Number _____________________________________
Date of Birth _____/_____ /_____
Current Grade Level ___________
FEDERAL LAW REQUIRES A SIGNED PARENTAL REQUEST BEFORE TRANSCRIPTS CAN BE RELEASED: I authorize the release of my child’s official transcript for the 2009-2010 school year and the current records for the 2010-2011 school year.
Signature of Parent(s) / Guardian (s) _________________________________
Date _____________________________
NOTICE TO SCHOOL OFFICE: Please mail a COPY of the official transcripts, including standardized test scores for the 2009-2010school year and the current records for the 2010-2011 school year. We do not need shot records, birth certificates, letter of recommendation, etc. at this time. Contact
Transcript copies should be mailed to:
Three Rivers Academy
445 Cotton Gin Rd.
Montgomery, Alabama, 36117
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