School District of Hortonville

HORTONVILLE HIGH SCHOOL ______Counseling Office 155 Warner St. Hortonville, WI 54944 Telephone: (920)779-7934 FAX: (920) 779-7909 Hortonville High School Transcript Request Form

Please allow 3 to 5 business days for processing from the time the request is received in our office. Hortonville High School MUST have the signature of the former student to release transcripts; parents may only sign if former student is under the age of 18.

Copies of transcripts are $2.00 each. Please send a check, cashier’s check or money order payable to: Hortonville High School You may also complete form and drop it off with payment in the Main Office or Counseling Office.

Today’s Date ______

The following information is needed in order to process your request:

Specific date transcript should be mailed: ______

Your Name: (include all names ever used) ______

Street Address: ______

City, State, Zip: ______

Phone: ______Cell Phone: ______

Email address: ______

Dates of Attendance (or year graduated): ______Date of Birth: ______

Mail ___ (# of copies) to: ______Address: ______

Mail ___ (# of copies) to: ______Address:______

Fax # (if transcript is to be faxed): ______To whose attention: ______

Signature: ______

Institutions must have written permission from any student 18 or older in order to release any information from a student's educational record. FERPA ACT

Mrs. Laura Kuether Counselor Mrs. Sally Ebben, Secretary Mrs. Marcia Piette, Counselor Mrs. Julie Patri, Registrar Ms. Alli Thompson, Counselor Mrs. Jodi Alix, School-to-Work Coord/Service Learning Coord.