Haverhill High School

137 Monument Street, Haverhill, MA 01832 Tel: 978-374-5716

Guidance Department Fax: 978-372-7419

REQUEST FOR TRANSCRIPT

DATE:_____________

I, _________________________ (Please Print Name Clearly), hereby give my permission for Haverhill High School to forward my high school records and other pertinent information.

_______________________ ____________________________

STUDENT SIGNATURE PARENT/GUARDIAN SIGNATURE

I graduated from Haverhill High School in ____________ Or

I am in grade ____ at Haverhill High School

Please send my transcript to:

Name: ____________________________________________________

Number & Street Address: __________________________________

City, State & Zip Code: _____________________________________

*PLEASE NOTE: Transcript requests will be processed within 48 hours. Incomplete addresses could result in a processing delay.

Date Mailed______________