Columbia High School

17 Parker Avenue

Maplewood, New Jersey 07040

Office Of Guidance And Counseling

973-762-5600, EXT 1032

http://tinyurl.com/somsdguidance

FORMER STUDENT TRANSCRIPT REQUEST FORM
Student: / Date:
(Print Name as it appeared while in attendance at Columbia High School)
Year Graduated: / or Year Left: / Date of Birth:
THERE IS A $3.00 FEE (CASH OR MONEY ORDER ONLY) FOR EACH TRANSCRIPT
Transcripts to be sent to the following: (Name and Address of College or Business—Please do not abbreviate.)
1.
2.
3.
Student’s Signature:
Current Address:
Home Phone #: / Work Phone #:
Cell Phone #: / Email Address:

SAT AND OTHER TEST SCORES ARE NOT INCLUDED.

YOU MUST REQUEST SCORES FROM ETS (EDUCATIONAL TESTING SERVICES), IF NECESSARY.

*PLEASE RETURN THE COMPLETED FORM AND APPROPRIATE FEE TO MRS. BELLINI IN THE COUNSELING OFFICE @ COLUMBIA HIGH SCHOOL, 17 PARKER AVE, MAPLEWOOD, NJ 07040

South Orange/Maplewood School District

525 Academy Street • Maplewood, NJ 07040 • Tel. (973) 762-5600