Lincoln-Sudbury Regional High School
Transcript Request Form
Please submit completed request and to:
Registrar
Lincoln-Sudbury Regional High School
390 Lincoln Road
Sudbury, MA 01776
Fax: 978-443-0118, or Registrar@lsrhs.net
There is a $5 processing fee for each transcript sent. Checks can be made out to LSRHS and sent to the address above.
Student Name (at time of graduation):__________________________________
Telephone Number: (___) ___-_______ Date of Transcript Request: __/__/____
Year of Graduation:__________________________ Date of Birth: __/__/____
Email: ____________________________________________________________
X ___________________________________________________________________
In accordance with the Family Education Rights and Privacy ACT of 1974,
I authorize, with my signature, the release of my student records to the parties
listed below.
Transcript(s) to be sent to:
Name:________________________________________________ Address:_______________________________________________ ______________________________________________________ City:____________________State:______ Zip:______________
|
Name:________________________________________________ Address:_______________________________________________ ______________________________________________________ City:____________________State:______ Zip:______________
|
Name:________________________________________________ Address:_______________________________________________ ______________________________________________________ City:____________________State:______ Zip:______________
|
Name:________________________________________________ Address:_______________________________________________ ______________________________________________________ City:____________________State:______ Zip:______________
|
Additional notes: