PORT GIBSON HIGH SCHOOL TRANSCRIPT REQUEST

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There is a fee of $3.00 for each transcript requested. Transcripts are processed on Tuesdays
and Thursdays and are available for pickup on Wednesdays and Fridays. Please allow two
days for processing.

*PLEASE NOTE: DUE TO THE RECENT SCHOOL CLOSURE, NORMAL PROCESSING DAYS WILL BE ALTERED. YOU WILL BE NOTIFIED ONCE YOUR REQUEST IS PROCESSED.

Delivery Method *

Pickup

Mail

Enrollment status *

Currently Enrolled

No longer enrolled

Year of Graduation *

Indicate Transcript Type *

OFFICIAL copy (signed & sealed envelope)

UNOFFICIAL copy

Faxed UNOFFICIAL copy to the following number

If faxed, please provide the fax number below? If this question does not apply to you, please TYPE (N/A) and skip to the next question. *

If mailed, please provide the mailing address below? If this question does not apply to you, please TYPE (N/A) and skip to the next question. *

First Name *

Last Name (Maiden/Former) *

Telephone Number *

Date of Birth *

YYYY

Last 4 Digits of SSN *

*Authorization of Release *

In accordance with FERPA, I, the above listed individual/student, hereby authorize Claiborne County School District to release information from my education record to the individual(s) named above and for the reasons specified. I acknowledge by my digital signature that I understand that although I am not required to release my information, I am giving my consent to do so. Additionally, I understand that I may revoke this authorization in writing at any time, except for that information which has already been released with consent and prior to my revocation.

Required

Signature of Authorize (Please Type Full Name Below) *

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