Transcript Request

Please complete the following information and submit as indicated. Allow ten school days from our receipt of this form for staff to complete your request. As of January 2017, CHA does not charge a fee to send transcripts.

Name *

Name

First Name

Last Name

Email Address *

Phone Number *

Phone Number

(###)

###

####

Graduation Year *

Diploma Type *

Transcript Type *

Transcripts cannot be emailed. Please check which delivery option you prefer. If you would like a transcript sent to more than one location please mark accordingly. Each address must be included for a transcript to be sent. You are responsible for sharing the correct address.

List Address(es) for Sending, if Applicable (Note: We cannot process transcript requests if addresses are incomplete.)

Name of College or University | Name of any contact person/department | Street Address | City, State, Zip

I give permission for Church Hill Academy to release my transcript records. Student Signature (please type name) *