Upper School Transcript Requests

*Student's First Name

*Last Name

*Grade

*Date Due to College/Organization (mm/dd/yyyy)

*College/Organization Name

*Number of Copies Requested

*Attention

*Address

*City

*State

*Zip Code

School Email Address to Receive Records

*Phone Number

*Fax Number

By typing my name below, I, the undersigned, authorize Mt. Bethel Christian Academy to send a copy of my child's official school Upper School transcript to the school or organization named above. If applicable, I also authorize Mt. Bethel Christian Academy to send, upon availability, my child's mid-year and end-of-year official Upper School transcript to the school or organization named above.

*Electronic Signature of Parent/Legal Guardian

*Date (mm/dd/yyyy)