TRANSCRIPT REQUEST FORM – Hillside School and Learning Center

OFFICIAL TRANSCRIPT REQUEST FORM

Date Requested: *

Graduation Year: *

Name of Student: *

First

Last

Date of Birth: *

Parent/Guardian #1 Name: *

First

Last

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Phone #:

Email Address: *

Please send a copy of my official transcripts (or other records) to: *

Payment - Please make payment within 7 days or you will need to resubmit this form. *

in 5 business days ($5.00 per transcript or record) -after payment is received
next business day ($10.00 per transcript or record) -must receive request and payment by 11 am to be mailed next business day

Method of Payment:

Method of Payment: Please make payment within 7 days or you will need to resubmit this form.
Pay by Credit Card - I will be calling the school office at 818.790.3044 to pay by credit card. (A 3.7% + $0.15 will be added to all credit card payments.)
Pay by Check - I will be dropping off or mailing a check to: Hillside School, 4331 Oak Grove Dr., La Canada, CA 91011. ($35 fee is charged for any returned check.)

Name