Education Verification 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'.

We may respond to this corporate request by the medium of our choosing (email, mail, or fax). You will be notified of the delivery mechanism by email. Status can be checked via the 'Order Tracker'

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.

Corporate Requestor Information:

Corporate Name: ^(legal)

Federal Tax ID:

Business Client Name:

Internal Tracking ID:

Contact Name:

Corporate Address:

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

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

^Primary:

^Cell:

Updates via Text Message?

Yes No

Email:

^Address:

^Confirm:

Student's 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 Student's Birth:

Date of Birth:

Current Age:

Student's Last Brunswick School of Attendance:

Name of School :

Last Year Enrolled:

Did they graduate?

Yes No

Student Current Name:

Last Name: ^{(official id)}

First Name:

Middle Name:

Maiden Name:

Suffix:

Student's 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

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

Address Line 1:

Address Line 2:

City:

State: ^(region)

Zip Code: ^{(postal code)}

Country:

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

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

Special Instructions :

Reason(s) for Request of Student Record:

Employment

College

Identification

Birth Certificate

Immigration

Other

Select The Information Type(s) Requested:

Verification of Graduation

( $20.00 ea. + $20.00 copy )

High School Transcript

( $20.00 ea. + $20.00 copy )

Additional Student Record Request (Please specify in the special instructions section above)

( $20.00 ea. + $20.00 copy )

Total Fee:

AUTHORIZATION NOTIFICATION:

I hereby certify and verify that my corporation has expressed written consent to release information from the former student of Brunswick County Schools for which this request is made. I understand that the recipient of the record(s) will use said 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 the expressed written consent of the former student except under authority of Public Law 93-380, Educational Rights and Privacy Act. By clicking 'Proceed to Checkout', I certify this information as complete and accurate.

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.

Coupon Code:

Your Initials:

Pay by Money Order

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Online Corporate Information Request Step 1, Please Enter All Information