Student’s Name_________________________________________________ Birth Date ____________________

SS#_______-_______-_______                                      Phone Number ____________________________________

 

Current Mailing Address ______________________________________________________________________

City____________________________________________  State_____  Zip Code ________________________

 

Parent’s Name _____________________________________________  Email ___________________________

 

Parent’s Phone Number ______________________________________

 

I certify that I am the legal guardian of the above named student and we are requesting that an official transcript from Marlboro Academy be sent to the institutions listed below.

Signature of Parent/Guardian _____________________________________ Date _____________________

 

Signature of Student ____________________________________________ Date _____________________


Please give the name and address of the college to which your transcript needs to be sent.  You must complete all the
information in order for this request to be processed.

 

College: ____________________________________________________________________________________

 

Address:____________________________________________________________________________________

 

               ____________________________________________________________________________________

Check ONLY ONE:

 

_____  Mail with College Applicaton
_____  For Scholarship
_____  For withdrawal from Marlboro Academy
_____  Mail Final Transcript After Graduation



Routing: (**For Office Use Only**)

Date Rc’d ________      Finance Office_______   College Placement Office ______     Homeroom Teacher _____

Marlboro Academy
Official Transcript Request Form

Return completed form to College Placement Counselor

·          Transcripts will not be issued for students with an outstanding balance or unfulfilled obligation to Marlboro Academy.

·          Please allow a week for processing of this request.