Alumni Transcript Request | Brunswick County Schools Transcript and Records Request

This is an official request for an aspect of the student record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process through payment of the 'order fee'.

The fee payment will be paid through Amazon Payments. The charge will show on your credit card statement as 'ASISchoolRecords' This is a secure and trusted provider of payment services.

Name While Attending School:

Last Name: ^{(in school)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Last 4 SSN:

Last 4 SSN: ^(confirm)

Student ID:

Information Related To Your Birth:

Date of Birth:

Current Age:

Birth City:

Birth State:

Birth Country:

Your Last Brunswick School of Attendance:

Name of School :

Last Year Enrolled:

Did you graduate?

Yes No

Current Name / Requester Name:

Last Name: ^{(official id)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Current Residence Address: ^{(this may be different than the mailing address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

^{Mailing Address Different:}

Yes No

Current Mailing Address: ^{(if different from residence address)}

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

Telephone Number: ^{(###-###-####)}

^Primary:

^Cell:

Updates via Text Message?

Yes No

Driver's License: ^{(or other State Issued ID)}

^{ID Number:}

^{Issuing State:}

Email:

^Address:

^Confirm:

Special Instructions :

Documents Will Be Delivered To: ^{please enter the delivery addresses}

	Name	Attention	Addr 1	Addr 2	City	State	Zip	Country	# of Copies

I would like express shipping!

Common Application Number: ^{(the identifier provided by 'www.commonapp.org')}

^{Common Application Number:}

NCAA Application Number: ^{(the identifier provided by 'www.ncaa.org')}

^{NCAA Application Number:}

Reason(s) for Request of Student Record:

Employment

College

Identification

Birth Certificate

Immigration

Other

Select The Information Type(s) Requested:

High School Transcript/Verification of Graduation

( $10.00 ea. + $10.00 copy )

Verification of Birth Date

( $10.00 ea. + $10.00 copy )

Immunization Records

( $10.00 ea. + $10.00 copy )

Total Fee:

AUTHORIZATION NOTIFICATION:

My initials below constitute an electronic signature and authorizes the Records Department of Brunswick County Schools to release information and / or my student record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.

I have enclosed the correct fees and understand that they are nonrefundable. I understand that an incomplete form will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.

Please enter your e-Signature

Your Initials:

For security purposes, we logged your IP Address: 18.217.118.7, 162.158.79.12, 30.1.3.114

Coupon Code:

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Online Student Records Request Step 1, Please Enter All Information