LOUDOUN COUNTY PUBLIC SCHOOLS
REQUEST FOR TRANSCRIPTS TO BE SENT TO OTHER SCHOOLS, ORGANIZATIONS OR
SCHOLARSHIP SPONSORS
I hereby request that a transcript of the scholastic records,
and, if applicable, the disciplinary record if requested, of
Cost:
$3.00/ transcript
Student’s Name
be sent to the following schools, organizations or scholarship sponsors.
Early Action,
Early Decision or
Regular Decision
(please indicate)
School, Organization, or
Scholarship
Address
Deadline
Date of
Request
Date
Processed
Scores on the SAT Reasoning and Subject tests, Advanced Placement Exams, and ACT should be
sent directly from the College Board or ACT at the request of the student.
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I give permission to send my Social Security Number with my transcript.
I give permission to give my transcript to high school and college coaches who request it.
Student’s Name — PRINT or TYPE
Student’s Signature
Parent’s Signature (if student is under 18)
RT-10
Revised 10-27-05