Full Name (as it appears on your school records)

Date of Birth

Acellus ID (Optional)

Email Address

Phone Number

Mailing Address (required for mailed transcripts and diploma reprints)

What records are you requesting? What records are you requesting? Digital Transcript (delivered via email) — No fee Certified Transcript (delivered via postal mail) — $5* Reprint of High School Diploma — $25* Other (please specify in the space below)

Comments (Optional: Please provide any special instructions on where to deliver your transcript, etc.)

Certification Certification I certify that I am the former student named on this form, that I am 18 years of age or older, and that the information I have provided is true and accurate. I understand that Acellus Academy may verify my identity before releasing any records.