AUTHORIZATION/REQUEST FOR RELEASE OF TRANSCRIPT
Print, fill out and mail to school for a copy of your Transcript.
Please enclose $1.00 per Transcript Requested, along with a copy of a picture ID.
Include a self-addressed, stamped envelope for return of Transcript.
Student name at time of attendance: ___________________________________________________________
Date of Birth: _____________________________ Year last attended or graduated: _________________
Number of copies requested:_____________ Total amount enclosed:__________________________
Please list your current phone number in case of any questions:____________________________________
I authorize Southmoore High School Registrar to release official copies
of my High School Transcript.
_______________________________________________________________
_____________________
Signature
Date
If you want your Transcript forwarded to a college or university, please provide the
following information:
College/University Name: ________________________________________________________________________
Address:______________________________________________________________________________________________
City/State/Zip:______________________________________________________________________________________
Attention:____________________________________________________________________________________________
Mail completed form to:
SOUTHMOORE HIGH SCHOOL
Office of the Registrar
2901 S. Santa Fe
Moore, OK 73160