ICHS Transcript Request Form | Immaculate Conception High School

Official Transcripts must be sent directly to the requesting institution / place of employment.
Transcripts will not be sent to a home address

You must submit a separate request form for each transcript.

**Please note this is Immaculate Conception High School in Lodi, NJ**

Current Contact Information

Requester Name *

First

Last

Relationship to the student whose transcript you are requesting: *

Self
I am the student’s parent/guardian
Other

This information helps us to understand the request.

Requester Email *

We will work to acknowledge when the transcript has been sent to the institution/place of employment.

Requester Phone # *

Identity Information

Name while in attendance at ICHS *

First

Last

Year of Graduation (or last year attending ICHS) *

Date of Birth *

Please upload a photo of an ID or identity document showing your Name and Date of Birth (School ID, Drivers License, etc.) *

Click or drag a file to this area to upload.

Transcript Information

Official Transcripts must be sent directly to the requesting institution / place of employment.
Transcripts will not be sent to a home address

Name of Requesting Institution / Place of Employment *

Name of contact person at institution / place of employment *

First

Last

Email of the contact person at the institution / place of employment *

Address of Requesting Institution / Place of Employment *

Address Line 1

Address Line 2

City

State

Zip Code

Authorization to Release Transcript

You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this release form and therefore you authorize the release of a copy of the transcript (school records) concerning the student name provided on this form to the requesting institution / place of employment.

Signature *