Transcript Request

Please make sure you respond to all sections of the Transcript Request form. This form may also be used to request special education and immunization records.

Required

Centerville City Schools
Office of Student Services

RECORD REQUEST

This form is for graduates/former students ONLY.

Current Centerville High School students should see their guidance counselor to request their transcripts.

Allow 2 business days for the processing of this request.

Please check the records you are requesting.required

Transcript

Immunizations

Special Education

Date of Requestrequired

Must contain a date in M/D/YYYY format

Student Namerequired

First Name

Middle

Maiden (optional)

Last Name

Date of Birthrequired

Must contain a date in M/D/YYYY format

Year of Graduationrequired

Address (include number, street, apt. # if applicable, city, state and zip)required

Phone Numberrequired

Example: 937-123-4567

Email Addressrequired

Please confirm.required

I acknowledge that the information provided on this form is correct.

Please forward official record to address(es) provided below:

College Name & Full Address (if applicable)

Transcript Request

Centerville City Schools Office of Student Services

Centerville City Schools
Office of Student Services