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High School Diploma Online Transcript Request Form

Please complete the form below. Required fields marked with an asterisk *

Name of School Last Attended: *

City, State

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I attended that school under the name of:*

Last, First, Middle

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Attended from: *

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Attended To:*

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Date of Birth*

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Best number to reach you*

Number Required

Note - Please not send the student's CUME file

Please email a copy of my transcript to:

Juliana Castro ([email protected])

Ukiah Adult School

1056 N. Bush Street

Ukiah, CA 95482

Or fax to: (707) 463-0718 attn: Juliana Castro

By checking this box, and typing my name below, I am electronically signing this transcript request form. I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.*

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Please type your full legal name: *

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Confirmation Email

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