Your name (first, middle, last):  _____________________   ____   _____________________________

Name when enrolled, if different:  _____________________________ Date of Birth _______________

Date of most recent enrollment:  ______________     Social Security No.  _______________________

(Note:  Berea High ONLY has records from 1985 to present.  Requests for records prior to 1985 must be made from
 the School District of Greenville County, 301 Camperdown Way, Greenville, SC  29602)   Telephone:  864 355-1604

Your mailing address:  ______________________________________

                                  ________________________________________

                                  ________________________________________

Your telephone number(s):  (H)_____________________    (B)_______________________

Transcript type (check one):
( )  Unofficial - issued to requester (unsealed)
( )  Official - copy to be mailed to you, addressed to recipient shown below (sealed)
( )  Official - copy mailed to recipient shown below (sealed)

Name and address to which official transcript should be sent:

. . . . . .

Number of copies to this recipient:  _____

Each transcript costs $3.00.  If mailing, please do not send cash in the mail.  Make money orders out to Berea High School.  No checks please.

Your signature (required) __________________________________     Today's Date: _______________

Please note that the Family Educational Rights and Privacy Act of 1974 requires that all transcript requests be
in writing, signed and dated by the person to whom the record belongs.