Edina High School
6754 Valley View Road
Edina, MN 55439
(952) 848-3800
Payment and a signature are required for processing. The fee for each transcript is $5.00.
Transcripts will be sent out first class mail within 2-5 days of receiving this request.
Print out and complete this entire form and mail it along with payment (payment can be made by
check or money order made payable to Edina High School) to:
Edina High School
Attn: Counseling Department
6754 Valley View Road
Edina, MN 55439-1761
Name: ___________________________________ _____________________________________ _______
Last First M.I.
Maiden or Former Name: ________________________________________________________________
Date of Birth: _______________________________
Year of Graduation: ________________ OR Dates of attendance: ___________________________
Current Address: _________________________________________________________________________
Phone #:
(Required for contact if there is a problem processing the request.) ____________________________________________
SEND TRANSCRIPT TO: (Please Print)
1. Institution/Organization: ______________________________________________________________
Attention: ______________________________________________________________
Street Address: ______________________________________________________________
______________________________________________________________
City, State and Zip Code: ______________________________________________________________
2. Institution/Organization: ______________________________________________________________
Attention: ______________________________________________________________
Street Address: ______________________________________________________________
______________________________________________________________
City, State and Zip Code: ______________________________________________________________
3. Institution/Organization: ______________________________________________________________
Attention: ______________________________________________________________
Street Address: ______________________________________________________________
______________________________________________________________
City, State and Zip Code: ______________________________________________________________
I hereby authorize Edina High School to release my transcript to address(es) listed above:
Signature: ____________________________________________________________ Date: __________________
FOR OFFICE USE ONLY
Date Request Rec’d: __________ Date Transcript Mailed: _________ Fee Paid: $__________ Sent By: _________
Official Transcript Request Form
Former Edina High School Student
7/09
Please include ACT/SAT
test scores if available
