TRANSCRIPT REQUEST

ROXBURY HIGH SCHOOL

GUIDANCE DEPARTMENT Date: _______________________

Counselor: ___________________

Please send a transcript of my high school record to the following college:

NAME OF COLLEGE:

_____________________________________ Application Fee:

( ) MY APPLICATION IS ATTACHED ( ) Enclosed

( ) I DID MY APPLICATION ON-LINE ( ) Not enclosed

( ) I WILL BRING IN MY APPLICATION

( ) DO NOT RELEASE STANDARDIZED Year of Graduation ___________

TEST SCORES WITH MY TRANSCRIPT

( ) COMMON APPLICATION USED

_______________________________________ ____________________________________

Parent’s Signature (if under 18) Student’s Name (PRINT)

_______________________________________ ____________________________________

Date Transcript Sent Student’s Signature