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Transcript Request Form

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Subject
First Name (Required)
Middle Name
Last Name (Required)
Former name used at the time of enrollment (if applicable)
Email Address (Required)
Phone Number
Social Security Number (Required)
Current or last grade attended at NYOS Charter School (Required)
Current or last year attended at NYOS Charter School (Required)
Year of High School Graduation (if applicable)
I am requesting a transcript and I would like a transcript to be sent via the following method (Required)
If you are requesting a transcript to be emailed, please provide preferred email address
If you are requesting a transcript to be faxed, please provide fax number
If you are requesting a transcript to be mailed, please provide full mailing address
Authorization to release records: I authorize NYOS Charter School to release the information above in the manner which I have requested. *FERPA (Family Educational Rights and Privacy Act) is a federal law that gives parents the right to have access to their child's student records. When a student turns 18 years old or enters a post-secondary institution, FERPA rights are transferred from the parent/guardian to the student. (Required)
Requestor's Full Name (Required)
Requestor's Phone Number (if different from above)
Requestor's Email Address (if different from above)
Requestor's Relationship to Student (Required)
Signature (Required)
Today's Date (Required)
Email (Optional)
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