Request for Release of Official Transcript and Records

To the Transcript Clerk:

The student below attended your school and is planning to enroll in Putnam County Adult High School.  Please FAX a copy of the transcript as soon as possible.  Also, MAIL a complete official copy to PCAHS.

The mailed copy should include the following information:
  • Transcript of all credits including any partial credits earned
  • Testing results (TCAP, Exit exam and Gateways/Writing Assessment-information from TN schools)
  • ALL COURSES AND GRADES AT THE DATE OF WITHDRAWAL IF THE STUDENT LEFT BEFORE THE END OF THE GRADING PERIOD, E.G. 9 WEEK OR MIDTERM REPORTS.
  • Health records
  • Disciplinary actions and records

If you are unable to forward these records (i.e. burned or lost records, uncollected fees, records transferred to another location, etc.), please list the problem and return this form to us.  Thank you for your cooperation and prompt attention to this matter.

Sincerely,

Jimmie N. Webber

PCAHS Principal

webberj@k12tn.net

Please ATTACH THIS FORM to the student’s records and transcript and send to:

TRANSCRIPT/RECORDS
Putnam County Adult High School
1060 East Spring Street
Cookeville, TN 38501
phone # (931) 528-8685
fax # (931) 526-8133
Your name as it appeared on high school record:
Your SSN: Your Date of Birth:
Last grade you attended: Last year you attended school:
I GRANT PERMISSION TO RELEASE ALL OF MY RECORDS AND TRANSCRIPT TO PUTNAM COUNTY ADULT HIGH SCHOOL FROM:

School’s name:

School Address:
Adult Student’s Signature: Adult Student’s Printed Name:

Current mailing address:

 

 Current home phone #:
Message phone #:
Today’s date: