Authorization for Records Release

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This authorization, when submitted, will become part of the applicant’s permanent record pursuant to Public Law 93-380. Please complete this form to request copies of transcripts, immunization records or duplicate diplomas. Payment instructions will be sent upon completion of the form.

Transcripts for graduation years prior to 2011 are not yet stored electronically and are contained in paper files at the high school. Therefore, more time may be needed to retrieve transcripts with graduation dates prior to 2011. Please contact Martina Middlebrooks, middlebrooks_m@shaker.org (216.295.4257) with any questions.

Email *

First Name *

Last Name *

Last Name at Graduation (if different from current last name)

Street Address *

City, State, ZIP Code *

Birth Date *

YYYY

Graduation Year/Year of Withdrawal *

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