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Request for Records
Request for Records
Request for Records Form
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Required
Your Information
Name
*
required
First Name
Last Name
Your name at the time of your graduation (if different)
First Name
Last Name
Mailing Address
*
required
City
*
required
State
*
required
Zip Code
*
required
Email Address
*
required
Phone Number
*
required
Date of Birth
*
required
Must contain a date in M/D/YYYY format
Graduation Year
*
required
Which school did you graduate from?
*
required
Bolivar-Richburg
Bolivar
Richburg
Records Being Requested
Which specific document(s) are you requesting?
*
required
Transcript (official copy)
Transcript (unofficial copy)
Immunization Record (be advised, we do not keep all records)
Forward My Records
Please provide the name, address and phone number of the institution where you need the records sent. If you need the records faxed or emailed, please include that information as well.
Institution Name
Institution Mailing Address
Institution City
Institution State
Institution Zip Code
Institution Fax Number (if applicable)
Institution Email Address (if applicable)
Institution Phone Number (if applicable)
Contact Person (if applicable)
Additional Notes or Instructions
Submit