Clover Park School District

Clover Park School District does not discriminate in any programs or activities on the basis of sex, race, creed, religion, color, national origin, age, veteran or military status, sexual orientation, gender expression or identity, disability, or the use of a trained dog guide or service animal, and provides equal access to the Boy Scouts and other designated youth groups. Address correspondence to one of the following individuals who have been designated to handle questions and complaints of alleged discrimination at Clover Park School District, 10903 Gravelly Lake Dr., SW, Lakewood, WA 98499-1341: Title IX Coordinator, Section 504/ADA Coordinator, Civil Right Compliance Coordinator Greg Davis, Executive Director of Compliance and Student Services Contact the Executive Director of Compliance and Student Services (253) 583-5154

Current Name	Last	First	Middle Initial
Maiden name or other name used while attending high school:
Current Address:
City: State: Zip:
Phone: Date of Birth:
Name of the last school you attended in Clover Park School District:
Last year you attended school in Clover Park School District:
Did you graduate? Yes No
Do you need this to be an Official Transcript for School or Employment? Yes No
*If YES, please do not open the envelope that the Transcript arrives in. This will invalidate the Transcript.*
Number of transcript copies needed:		Amount enclosed: $ ($3.00 for each copy requested)
Mail Transcript to:
Fax Transcript to:
Email Transcript to:

Clover Park School District

CPSD Transcript Request Form

High School Transcript Request

This signature authorizes the release of my transcript, to be forwarded as requested above.
Signature	Date

Send Money Order or Company Check ONLY for $3.00 per transcript. Make payable to: Clover Park School District Personal checks will not be accepted. Cash will be accepted in person only.
Mail completed form and fee to: if not addressed exactly as shown, mail often goes missing	TRANSCRIPTS Clover Park School District Student Services Department 10903 Gravelly Lake Drive SW, #5 Lakewood, WA 98499-1341