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:
________________________________________________________________
________________________________________________________________
________________________________________________________________
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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.