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Myagmarjav Bold mqb5478 928253472 High School Transcript/School Records Release Form Student: High school transcripts must be mailed or faxed directly from the high school to Penn State. Complete the student portion of this form and send it to your high school. Your high school may have additional requirements, such as a fee, before sending a transcript. Visit admissions.psu.edu/info/future/ for information for future students. Student Name:_______________________________________________________________ Name Used While in High School: ___________________________________ Date of Birth: ___________________________________ Year of Graduation: ________ If you did not graduate, date withdrawn from school:________ Student Street Address:________________________________________________________ City, State, and Zip:__________________________________________________ Phone:______________________________________________ _______________________________________ Student Signature _____________________ Date School Principal, Headmaster, or Counselor: The student listed above is requesting an official high school transcript be sent to Penn State. A faxed transcript is considered official if faxed with this form directly from the high school to Penn State. Only faxes with this cover sheet should be sent to: 800-835-7056. A transcript released directly to a student must be received by Penn State in an envelope sealed by the high school. A transcript may be faxed or mailed; it is not necessary to do both. If there are extenuating circumstances involving a student record, please send a letter of explanation or contact the Undergraduate Admissions Office at: admissions@psu.edu or 814-865-5471. If mailed, this form, the high school transcript, and any supporting materials should be sent to: Undergraduate Admissions Office The Pennsylvania State University 201 Shields Building University Park, PA 16802 Name of High School:_______________________________________________________________ Phone: ___________________________ Fax Number:__________________________ Name of School Official: _____________________________________ Email Address:_______________________________________ Signature: _____________________________________________Date: _____________________ U.Ed.EMA 11-250
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