RELEASE OF RECORDS FORM
STUDENT NAME______________________________________ CLASS OF __________________
STUDENT ID # _______________
STUDENT DATE OF BIRTH_____________________
___ I give permission for my transcript to be sent to the colleges, scholarships, the military and/or
programs listed below:
(Transcripts include courses taken, final grades, GPA, cumulative rank and attendance data)
*Some colleges and/or the Common Application require a NPHS official to complete a Secondary School
or Counselor Report. This paperwork MUST be submitted to the Transcript Office with this form.
Signatures: STUDENT
Signature___________________
PARENT/GUARDIAN
__________________
(required if under 18)
Signature
Please Check:
[] I have/will send my SATs through College Board
[] I have/will send Teacher recommendations through my teachers
College/Program
Common
Application
YES/NO
Early Decision
Early Action
Application
Due Date
$2.00
Paid
Request
Date Rec’d
“Details On The Reverse Side”
**ALLOW 3 WEEKS FOR PROCESSING **
(After the 10th day of school)