School Transcripts

REQUEST FOR TRANSCRIPT / MEDICAL RECORDS
DISTRICT RECORDS
SCHOOL DISTRICT U-46
(PLEASE PRINT)

NAME OF STUDENT WHILE ATTENDING U-46 SCHOOLS (MAIDEN NAME)
____________________________
BIRTHDATE___________________________________
LAST U-46 SCHOOL ATTENDED

____________________________
DATES ATTENDED/GRADUATED

______________________________
YOUR PHONE NUMBER

I AM REQUESTING THEFOLLOWING RECORDS:
# of copies

________ ALL MY RECORDS (elementary, middle, and high school records, test scores, and medical)
________ CERTIFIED OFFICIAL TRANSCRIPT (sealed envelope)
________COPY OF MY TRANSCRIPT (not official)
________ ACT SCORES
________ MEDICAL RECORDS ONLY
________ I WILL PICKUP MY RECORDS

Please mail my transcript/medical records to:
Name/Institution/Agency_________________________________
Address_______________________________________________
City________________________ State_________Zip _________
Attention to:________________________________________

______________________________________

_________________

STUDENT’S SIGNATURE

DATE

There is a $3.00 charge for transcripts/medical records, plus $1.00 for additional copies.
Thedistrict requires a copy of your Driver’s License or State ID with a request.
It takes 5 working days to process all requests from the date request is received.
Express 24 hours service is availablefor an additional fee of $7.00.
(Only cash, cashier’s check, money orders, and credit card payments are accepted, NO PERSONAL CHECKS)

PLEASE MAIL REQUEST & PAYMENT TO:
SCHOOL DISTRICT U-46DISTRICT RECORDS OFFICE
355 EAST CHICAGO STREET
ELGIN, ILLINOIS 60120
Ph: 847-888-5000 x5693 Fax: 847-608-2759

CREDIT CARD PAYMENT
TYPE: ______VISA, ______MASTER CARD
CARD NUMBER: _ _ _ _- _ _ _ _-_ _ _ _ -_ _ _ _
EXP. DATE: ___/___
CCV CODE: _ _ _
NAME ON CARD: __________________________

-------------------------------------------------------------OFFICE USE ONLY
Microfilm

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