TRANSCRIPT RELEASE FORM-St

TRANSCRIPT RELEASE FORM St. Dominic High School

______Name of Student Date of Birth Today’s Date Year of Graduation

I authorize by my signature the release of my transcript, test scores and related information to the school(s) indicated below.

______Student’s Signature Parent’s Signature *(If a student is under 18 yrs old, a parent signature is required.)

Please check all that apply:

____ Benedictine College ____ St. Charles Community College ____ Central Methodist University ____ Southwest Baptist University ____ Columbia College ____ St. Louis College of Pharmacy ____ Dominican University (IL) ____ St. Louis University ____ Drury University ____ Southeast Missouri State University ____ Fontbonne University ____ Southern Illinois University (please circle which campus) ____ Lindenwood University Edwardsville Carbondale ____ Loyola University of Chicago ____ Truman State University ____ Maryville University ____ University of Arkansas - Fayetteville ____ Missouri Baptist University ____ University of Central Missouri ____ Missouri Southern University ____ University of Kansas ____ Missouri State University ____ University of Missouri (Columbia) ____ Missouri Univ. of Science & Tech ____ University of Missouri (Kansas City) ____ Missouri Western University ____ University of Missouri (St. Louis) ____ Missouri Valley College ____ Washington University ____ Northwest MO State University ____ Webster University ____ Quincy University ____(other)______Rockhurst University ____(other)______

If “other” please provide a name of the school and mailing address of where the transcript(s) should be sent:

College/University Name: ______College/University Name: ______

Address: ______Address: ______

State: ______Zip:______State:______Zip:______

College/University Name:______College/University Name:______

Address: ______Address: ______

State: ______Zip:______State:______Zip:______

Each student is responsible for his/her portion of a college application. A school transcript will include an official (sealed) transcript with ACT scores. Any guidance or teacher recommendations must be requested.

______Date Received Date Processed Date Sent