Transcript Request Form*

Applicant’s Name

_________________________________________________________________

Last Name                   Maiden Name               First Name               Middle Initial

Date of Birth                          Graduation Year                   Date of Request

___________                          _______________                  ______________

I hereby authorize the release of this transcript of my academic record and request

It be sent to:____________________________________________.

Signature                                                                                Date

*Transcripts at Harmony High School include name of course, grade earned in course, credit received for each course, class rank, G.P.A., SAT scores, ACT scores and PSSA Test scores.