Transcript Request The following form is to be used to request transcript and/or immunization records for students that attended or graduated from an Elkhorn High School. Graduates and Transfer students only. Current seniors contact your counselor. STUDENT INFORMATIONSTUDENT NAME* First Middle Last STUDENT LEGAL NAME AT THE TIME OF GRADUATION* First Middle Last DATE OF BIRTH* MM slash DD slash YYYY HIGH SCHOOL* Elkhorn High School Elkhorn North High School Elkhorn South High School DID THE STUDENT GRADUATE* Yes No YEAR OF GRADUATION or LAST YEAR ATTENDED*Make a selection202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925YEAR OF GRADUATION or LAST YEAR ATTENDED*Make a selection20232022202120202019201820172016201520142013201220112010YEAR OF GRADUATION or LAST YEAR ATTENDED*Make a selection2023202220212020RECIPIENT INFORMATIONDOCUMENT TYPE* Official Transcript Unofficial Transcript Immunization RECIPIENT NAME* First Last ORGANIZATION, INSTITUTION, and/or DEPARTMENT NAME PHONE NUMBER*Used only if we need to contact youNEEDED BY*Date the document is needed MM slash DD slash YYYY RELEASE DOCUMENT(S) VIA* Mail Email Fax ADDRESS*Enter the address where the document(s) will be sent. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMAIL*Enter the address where the document(s) will be emailed. FAX*Enter the number where the document(s) will be faxed.OTHER COMMENTSCONFIRMATIONCONFIRMATION EMAIL I would like to receive a confirmation email upon submission of this form. EMAIL ADDRESS* NameThis field is for validation purposes and should be left unchanged.
