REYNOLDSBURG CITY SCHOOLS

Please mail/fax completed form to: RHS Alumni Records Request 7244 E. Main Street Reynoldsburg, OH 43068 Phone: 614-501-1036
Fax: 614-501-1050

Please note: Official School Records take up to five school days to process.
	You MAY NOT use this form to request a transcript.

GRADUATE INFORMATION:

Print Name: ______________________________________________________________________ (Please include maiden name if applicable.)

Address: _________________________________________________________________________

City: _______________________________ State: ____________

Graduation Year: ______	Date of Birth: _____/_____/______

Daytime Phone: (_____) ______-__________

Email address: _________________________________________

I give my permission to Reynoldsburg High School to release an Official record to the institution or agency name below:

Zip Code: __________________

Document Requested: (Check all that applies) Immunizations Records

IEP/504 Records
Other _________________________

Signature of Graduate: _______________________________________	Date: ________________

Institution Name: __________________________________________________________________

Address: _________________________________________________________________________

City: ____________________________________ State: ________________	Zip ______________

Fax Number: (____) _____-________	ATTN: __________________________________________

Alumni Records Instructions (please check box that applies)

Mail to Institution address above	Fax to number above	Graduate will pick up Mail to Business address above Mail to Graduate address above	Email to Graduate

********************************************** For School Use Only ****************************************************** Received by:	______________	Date Received:	___/____/____	Time: ____________

Prepared by: _______________	Date Mailed:	___/____/____	Date Emailed:	___/____/____

Date Faxed:	___/____/____	Date for Pick-up:	___/____/____	Time: ___________