The Oklahoma School of Science and Mathematics,
Indian Capital Technology Regional Centers
Transcript Request Form

TO THE APPLICANT AND PARENT/GUARDIAN

Complete the information requested and give this form to your guidance counselor.
Name of applicant: ________________________________ Grade: ____________________
AUTHORIZATION FOR RELEASE OF EDUCATION RECORDS
In accordance with federal regulations regarding the privacy rights of parents/guardian and students under the Family Educational Rights and Privacy Act of 1974, the undersigned hereby consents to the release of all education records about the above-named applicant to The Oklahoma School of Science and Mathematics, Indian Capital Technology Regional Centers, including recommendations and such other information as may be requested.

__________________________________________
Signature of Parent/Legal Guardian

________________ __________________________________________
Date Signature of Student
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TO THE GUIDANCE COUNSELOR

Instructions: The student named above has applied for admission to The Oklahoma School of Science and Mathematics, Indian Capital Technology Regional Centers. Please place the bottom portion of this page and the official transcript in a sealed envelope for the student to send in with the application. If this procedure is against your school’s policy, the transcript and request form may be sent separately to: The Oklahoma School of Science and Mathematics, Tahlequah Regional Center, 240 Vo-Tech Road, Tahlequah, OK 74464,
Attn: Wilson Fargo, by March 28, 2008.
1. How many students are there in this student’s current grade? _____________
2. STANDARDIZED TEST RECORDS
Please provide this information even if provided on the transcript.

ACT: Test date:_____________________

English_______ Math________ Reading________ Science________ Composite________
3.If ACT has not been taken, list the name of a Standardized Test administered within the past two years. Results from this test should accompany the official transcript

_________________________________________________
I certify that the information given above is correct regarding the secondary school records of:

Name of applicant:______________________________

Date______________

Signature of school official________________________________

The student’s official High School Transcript (with grades for at least the past three semesers of academic work) must be included with this form.

Founded 1990 for the People of Oklahoma