THE NEW YORK CITY DEPARTMENT OF EDUCATION
MARTIN VAN BUREN HIGH SCHOOL ____
230-17 Hillside Avenue
Queens Village, NY 11427
Tel: (718) 776-4728
Fax: (718) 776-6807
MARILYN SHEVELL Principal
***This Year’s Graduates do not pay any fee***
TRANSCRIPT REQUEST FORM/JOB VERIFICATION REQUEST
FEE: $5.00 Money Order – Payable to MARTIN VAN BUREN HIGH SCHOOL
(NO CASH – NO PERSONAL CHECKS)
(PLEASE PRINT CLEARLY)
Name of Student: _______________________________________________
Other NAME(s) used while attending School: ______________________
DATE/YEAR GRADUATED OR DISCHARGED: ___________________
Date of Birth: ____________________________________ _______________
Social Security #:_________________________________________________
Telephone#:_____________________________________________________
STUDENT’S SIGNATURE: _______________________________________
Please Check (X) on the document that is requested:
(Mailed directly ONLY to Colleges/Universities/Employers)
_____ OFFICIAL TRANSCRIPT ($5.00 Money Order)
(An Official Transcript bears the seal of the school and an authorized signature)
Name of College/ Employer: ___________________________________________
Address of College/Employer: ___________________________________________
___________________________________________
Fax# of College/Employer: ___________________________________________
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Mailed to Student:
_____ GRADUATION LETTER ($5.00 Money Order)
_____ IMMUNIZATION RECORD ($5.00 Money Order)
_____ UNOFFICIAL TRANSCRIPT - STUDENT COPY ($5.00 Money Order)
Student’s Mailing Address: _______________________________________________
_________________________________________________________________________
_________________________________________________________________________