*
Required
This signed form must be submitted and on file before any official school documents can be sent from Khan Lab School.
For the student named below, I authorize the release of school records, including an official transcript of all mastery progress for the years indicated below. By submitting this form electronically and printing my name below, this serves as my signature and becomes a binding contract.
Khan Lab School considers the electronic signature(s) below equivalent to a handwritten signature.
First
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required
Middle
Last
*
required
Class of (Year of High School Graduation)
*
required
Select Academic Year*
Please select the academic year(s) for the transcript(s) you are requesting.
Academic Year 2021-22
Academic Year 2020-21
Academic Year 2019-20
Academic Year 2018-19
Where to send the academic record (Institution or Program name) *
*
required
Type of academic record to be sent. If electronic, please note the email address of the recipient or the URL for uploading below:*
Electronic
Paper
Contact information (email, URL, link, or mailing address) for where you would like the academic record sent. If the academic record should be uploaded to Ravenna or another website, please note that information below.
*
required
When is the deadline for the academic record to be received?
*
required
(mm/dd/yyyy)
Please provide any additional information here.
Signature of student (print legal name)
*
required
Signature of legal parent/guardian
*
required
Requestor's email address:
*
required
Date:
*
required
(mm/dd/yyyy)
Please send a confirmation email to the address below: