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America's First Online K-12 Orthodox Jewish School with an Integrated Curriculum Since 5779

STUDENT TRANSCRIPT REQUEST FORM

Instructions:

Please, complete the form below to request your official transcript. A fee listed in the Schedule of Fees must be submitted with transcript request. Transcripts will only be released after all financial obligations to ITA are cleared.

Your Name*

Your Phone Number:*

Your Email Address:*

Relationship to Student (if not self):

STUDENT INFORMATION: *

Date of Birth*

Month

Day

Year

Student ID Number (if known)

Years Attended ITA: *

Graduation Date:

TYPE OF TRANSCRIPT REQUESTED:*

Official (Sealed for Institutions)

Unofficial (For Personal Use)

Delivery Method:*

Email (Provide Email Address in the Next Section)

Mail (Provide Mailling Address in the Next Section)

Please, provide email or mailing address:*

Purpose of Request:*

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PAYMENT CONFIRMATION*

I authorize ITA to release my transcript as requested above.

AUTHORIZATION TO RELEASE AND SIGNATURE:*

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Date of Request:*

FL Private School # 6357

College Board#102739

DUNS # 122361774

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20900 NE 30th Ave, Ste 200

Aventura, FL 33180

T. 786.471.7741

501 (c) 3 Non-Profit Status

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STUDENT TRANSCRIPT REQUEST FORM

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