PORTAGE HIGH SCHOOL

6450 US Highway 6 – Portage, IN 46368 – (219) 764-6046 (Registrar) – (219) 764-6063 (fax)

Family Educational Rights and Privacy Act

Authorization to release student information

There is a $2.00 fee for each transcript requested for a current student

and a $5.00 feefor all other transcript requests effective November 1, 2013.

I, the undersigned, hereby authorize Portage High School to release information and school records of the following student to the agencies listed below:

______

(Name of student at time of attendance) (Graduation year)

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Date of Birth Phone # where you can be reached if any questions arise

This information is being transferred on the condition that said agency will NOT permit any other agency to have access to said information without the express written consent as prescribed by the Family Educational Rights and Privacy Act of 1974 and acts amendatory and supplemental thereto. (This information could include grades, ISTEP, PSAT, AP, SAT and ACT test scores, immunization records, attendance, etc.)

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Student Signature (date signed)

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Parent/Guardian Signature (*if student is under 18) (date signed)

___I will pick up my transcript(s).___# of transcripts ordered

___Please send my transcript(s) to the following (include address if known):

___ Please send my FINAL transcript(s) to the following address

______

______

______

__Check if graduated from PORTAGE HIGH SCHOOL

___Check if graduated from PORTAGE ADULT EDUCATION & year ______.

___Check if took classes at Portage Adult Ed but did NOTgraduate.

Last year attended ______.

___Check if earned GED before 1985.

NOTE: GED’s earned 1985 to presentmustbe obtained through the

State at

*continued on backside

*Attention students taking Dual Credit Classes

  • The Majority of Dual Credit/Concurrent Enrollment Courses taken to satisfy requirements for the Academic Honors Diploma are listed on the Core Transfer Library.
  • If you desire to know how credits will transfer to a particular university or for your intended major, we advise you to contact the Registrar’s Office of that institution, or go to the institution’s website for course transfer information. You can also go to to see how the credits transfer within the state of Indiana. Please feel free to contact us with any further questions.