Form for Requesting a Transcript from Your High School or College

Student:
Please sign at the bottom of this document, indicating your consent for your high school or former college/university to release this information. Mail this form to your high school or former college.

High school or college/university registrar:
Please send this student's transcript to:

     Attn: Laura Parish/Virtual College
     Bay Mills Community College
     12214 West Lakeshore Drive
     Brimley, MI  49715

Student Information

First Name _________________ Middle Initial ____ Last Name ______________________

Date of Birth ____________________________

Social Security Number _____________________________

Student's Address ___________________________________________

City _________________________ State/Province ___________________

Zip/Postal Code  ___________________

High School/GED Information

Name of High School/GED Testing Site _____________________________

Address of School/Site ___________________________________

City  _______________________________ State/Prov _________________

Zip Code   ____________________

Dates Attended _______________________________

Graduation Date ______________________________

Approximate GED Completion Date __________________

"I hereby authorize you to release my High School Transcript/GED test results"

Student signature: _________________________________ Date _____________________