Senior Transcript Request Form

Falls Church High School CEEB Code: 470792

Student Name (Last, First, Middle Initial) Student ID Counselor Name

Student Email Address Telephone (student’s cell) Telephone (parent’s daytime)

 The first three (3) college transcripts are free. No postage is required. Falls Church does NOT mail standardized
 A $5.00 fee will be required for each additional transcript. Fees must be paid at the time of the request. test scores (SAT, ACT, TOEFL) to colleges.
 Payment can be made by cash or check or online using www.myschoolbucks.com
 Transcripts must be requested at least fifteen (15) school days prior to a college or scholarship deadline. You must request them directly through
College Board or ACT.

CONSENT FOR RELEASE OF STUDENT RECORDS IN SUPPORT OF POSTSECONDARY APPLICATIONS

Instructions for Use: This form is to be used by parents and/or guardians or students aged 18 or older to authorize FCPS to release student records and related information to support
student applications to colleges, universities, scholarship sponsors, employers, or other similar organizations. This consent form needs to be signed only once. The student, parent and/or
guardian will identify all schools and organizations to which records may be sent.
By my signature below, I authorize FCPS to release to any school or organization identified by me on my school’s transcript request form any of my school records or other information
about me that is requested by the school or organization in support of my application. This may include, but is not limited to, my transcript, other school records, and any letters of
recommendation written by FCPS employees. However, this authorization specifically excludes the release of discipline information.
By my signature below, I also authorize FCPS employees, including but not limited to, administrators, teachers, and counselors, to communicate with and respond to inquiries from the
school or organization concerning my application and my credentials.
FCPS may release the required records and information by electronic or other means directly to the school or organization or to a service used by the school or organization to facilitate its
application process. These services include, but are not limited to, the Common Application, Naviance, and/or Family Connection, and other services approved by FCPS.
I also understand that I have the right to review or have copies of any records that FCPS transmits to the school or organization. If I have responded yes to the statement below, however, I
have waived the right to review or have copies of any letters of recommendation written by FCPS employees.

 Yes, I waive my right to review or have copies of any letters of recommendation written by FCPS employees
 No, I do not waive my right to review or have copies of any letters of recommendation written by FCPS employees
My signature below confirms that I have read and understand this consent form.
Note: Both the parent and/or guardian and student are required to sign this form. Parent and/or guardian signature is not required, however, if the student is aged 18 or over or is
attending a postsecondary school.
(Form – IS-111)

Student’s Signature Parent/Guardian’s Signature (if student is under 18)

Student Name (Last, First, Middle Initial): ________________________________________

Print Neatly or Type: Delivery Type: Student Services Use Only

College Counselor
Name of College, Scholarship, or NCAA Common App.  Date Date
Application Letter
If applicable, please include specific campus and Decision Type Coalition Submitted Submitted/
Deadline Y/N Paid
City and State Electronic (eDocs)  to Student Mailed to
Date
US Mail (M)  Services School

 Early Action  Common App.

 Early Decision  Coalition
Example Only!! NVCC None N  Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

 Early Action  Common App.

 Early Decision  Coalition
 Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

 Early Action  Common App.

 Early Decision  Coalition
 Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

 Early Action  Common App.

 Early Decision  Coalition
 Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

 Early Action  Common App.

 Early Decision  Coalition
 Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

 Early Action  Common App.

 Early Decision  Coalition
 Regular Decision  Electronic (eDocs)
 Rolling Admission  US Mail

IMPORTANT INFORMATION AND INSTRUCTIONS: You MUST submit a Senior Questionnaire via Google Doc Forms one month prior to first deadline. These forms can
be found on the Falls Church High School website under Student Services then Counselor Letter of Recommendation.
Each transcript package mailed by Falls Church High School will include:

1. Your official transcript which lists all final grades through the end of your junior year, your cumulative grade point average and senior courses
2. Falls Church High School Profile
3. Secondary School Report and recommendation letter from your counselor if requested