TRANSCRIPT RELEASE FORM
Passaic County Technical Institute
45 Reinhardt Road
Wayne, New Jersey 07470
Telephone: 973.389.4230 – Fax: 973.389.2049
pctvstranscriptrequest@pcti.tec.nj.us
SCHOOL COUNSELING DEPARTMENT
I hereby give permission to Passaic County Technical Institute to forward my school records as listed below. The
transcript should include: (Please check what you wish to have included.)
x x
___All subjects taken with final grades ___Testing results
*THIS REQUEST TO PROCESS YOUR TRANSCRIPT SHOULD BE GIVEN TO THE PCTI SCHOOL COUNSELING
OFFICE AT LEAST TEN (10) SCHOOL DAYS PRIOR TO THE APPLICATION OR INTERVIEW DEADLINE.
210649
ID#: Full Name: junior soto
Date of Birth: 08/20/2002
Year of Graduation: 2021
Please check-off (√) if you graduated from the Adult High School Program:
Yes, I graduated through the Adult High School Program
• Telephone # where you can be reached: 8625964446
junior soto 10/20/21
Parent/Guardian Signature Date Student Signature, if over 18 years of age Date
Note: As determined by the “Privacy Laws” 98-380 passed by the 93rd Congress and in effect as of November 20,
1974, the written consent of a parent or student (18 years of age or older), is required for the release of any school
records.
PLEASE FORWARD MY TRANSCRIPT TO: myself
sotojunior082002@gmail.com
NAME OF COLLEGE / UNIVERSITY/BUSINESS, if applicable
TO THE ATTENTION OF
STREET ADDRESS AND/OR PO BOX
CITY, STATE & ZIP CODE
FOR OFFICE USE ONLY:
Date Received Date Sent/Mailed
