- Herbert H. Lehman High School

advertisement

HERBERT H. LEHMAN HIGH SCHOOL

3000 East Tremont Avenue, Bronx, New York 10461

(718) 904-4200 FAX (718) 904-5022

Mrs. Rose LoBianco

Principal

REQUEST FOR STUDENT RECORD/TRANSCRIPT

Name (print)_____________________________________Date of Birth____________________

Address________________________________________ Telephone #____________________

Name while attending Lehman (if different)__________________________________________

Date of Graduation or when last attended____________________________________________

What record is requested? (Official Transcript, Student Copy of Transcript, Immunizations,)

(Verification of Attendance or Graduation, and/or other)

To whom is record to be given or sent? (Check one or more)

_____ Self (student)

_____ **Other (identify) __________________________________

_____ Mail to address(es) below:

________________________________________________________________

________________________________________________________________

________________________________________________________________

****************************************************************************

Authorization: I hereby authorize you to give/send the record (s) I have requested above:

Signature_____________________________________ Date

____________________________

**Only with an original notorized letter from student.

Download