GREENVILLE AREA SCHOOL DISTRICT
AUTHORIZATION TO RELEASE PERMANENT SCHOOL RECORD FORM

 

Please submit completed form to Guidance Office - ATTN: Jean Pfaff - 9 Donation Road - Greenville, PA 16125

 

The Guidance Office of the Greenville Senior High School is authorized to release the permanent record of _____________________________ to the institution(s) listed below.  I understand this record will include official administrative record (name, address, birth date, grade level completed, grades, class standing and attendance record), standardized test scores, extracurricular activities and counselor recommendations (if other, please specify: ____________________________________ ).

 

Do you want your PSSA Test Results  forwarded if available?    _____ Yes   _____No

 

 

      Last year attending Greenville High School:  ___________

 

Address:  _________________________

 

                _________________________

 

                _________________________

 

Phone:  _______________________

 

E-mail:  _______________________

 

Other:  _______________________

 

 

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Signature of parent/guardian
(if student is under 18)

 

 

     Receiving Institutions:

 

______________________________

 

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