Transcript/Immunization Release Form.  
IMPORTANT: 
Colleges and Universities will only accept transcripts from the Delta County School District Office. They will not accept a transcript from you personally.  Please get the email address from the school you are applying at to have the transcript sent to before you begin this form. 

Please note that all requests may take up to 3 business days to complete. If you chose to have the documents mailed, please allow 10 days to receive the transcript or immunization record through the Postal Service. 

All questions are required to be answered.  

Please use "n/a" if the question does not apply.  

FERPA: The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. FERPA gives a parent/guardian (“Parent”) certain rights with respect to their children's education record. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level (an "Eligible Student"). The student education record of Eligible Students can only be released to a Parent with written consent from the Eligible Student, by providing other legal documentation, or by certifying the Eligible Student was a dependent for tax purposes the previous tax year.

In accordance with FERPA and under Delta County School District Policies JRA/JRC and JRA-JRC-E-1 a student’s education record will not be released to a third-party without written consent, unless such disclosure is permitted under FERPA.

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Email *
Name at Time of Graduation (Student's Full Name, first and last):  *
I would like: *
Date of Birth: *
MM
/
DD
/
YYYY
Daytime Phone Number (with area code): *
School Graduated From (or attended): *
Year of Graduation (or would have graduated): *
I would like my transcript: (select one, two or all three) *
Required
Mail transcript to (include school name or individual's name, address and zip code.  If you want your transcript mailed to more than 1 address, use a comma between all addresses). Use n/a if you do not want your transcript mailed. *
Email transcript to: Use n/a if you do not want your transcript emailed. *
Fax transcript to: (include area code). Use n/a if you do not want your transcript faxed. *
I would like my immunization record: (include school name, address and zip code.  If you want your transcript mailed to more than 1 address, use a comma between all addresses). Use n/a if you do not want your record mailed
 *
Required
Mail immunization record to: Use n/a if you do not want your record mailed. 
 *
Email immunization record to:  Use n/a if you do not want your record emailed.  *
Fax immunization record to:  Use n/a if you do not want your record faxed.  *
Type your name as your signature verifying that the information provided in this form is complete, true and correct, and to allow DCSD to forward your transcript or immunization record to the above indicated agencies (or people) by mail, email or fax. *
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