Examination Score Release Form
Submit your details and authorization to release your examination scores to a designated recipient.
Student Full Name
*
First Name
Last Name
Student ID Number
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Examination Name
*
Examination Date
*
-
Month
-
Day
Year
Date
Score to be Released (if known)
Recipient Name (Person or Institution)
*
Recipient Email Address
*
example@example.com
Preferred Method of Score Release
*
Email
Postal Mail
In-person Pickup
Other
Reason for Score Release
*
Please Select
Transfer Application
Scholarship Application
Employment Verification
Personal Records
Other
Signature of Student (Type or Draw)
*
Submit Request
Submit Request
Should be Empty: