High School Transcript Request (Alumni/Withdrawals)

Academic Record Request (Alumni/Withdrawal)

Guidance Office (610) 866-9660 ext 2319
Requestor's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Requestor's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Name and address where records are to be sent: *

Attention to:

Street Address

CityState

Zip CodeCountry
E-mail*
example@example.com
Did you graduate from Lehigh Valley Academy?*

YesNo
Year of Graduation or Withdrawal*
Type of Request:*
No. of Copies Requested:*
A $3.00 fee is required for each record request. Amount due ($):
Form of Payment:*
Payment in cash/check must be submitted in person before request can be processed.
SchoolPay Website for Payment
SchoolPay Confirmation Number
Lehigh Valley Academy High School 7-12

Please deliver cash payments (do not mail) to:

2040 Avenue C

Bethlehem, PA 18017
Make checks or money orders out to:

"LEHIGH VALLEY ACADEMY RCS" with "TRANSCRIPT REQUEST" in the memo and mail or deliver to:

2040 Avenue C, BETHLEHEM, PA 18107
I hereby request and authorize the release of the following records to the individual, institution, or agency listed and understand it may take up to 10 business days to process this request.*

Academic TranscriptOther
Signature*

Clear
YOUR REQUEST WILL BE PROCESSED WHEN PAYMENT IS RECEIVED.

Transcript requests can only be made by the student. Federal law prohibits parents from requesting transcripts for their children who have graduated or are over 18 years of age. If you have questions, please call the Guidance Office at 610-866-9660, ext. 2319
For Guidance Office Use:

Type of Payment:

Check#

Date Received:

Date Sent:
Should be Empty:

Academic Record Request (Alumni/Withdrawal)