Transcript
Request
Form
University of La Verne
and Chino Valley U SD
Online High School Program
(CVUSD)
- Summer 2023
Student’s Last Name:
Student’s First Name:
Date of Birth (MM/DD/YYYY):
Grade Level for 2022 - 2023 school year:
Parent/Guardian First Name:
Parent/Guardian Last Name:
Mailing Address:
City:
Zip:
Contact Number:
I do
not want
this
course added
to
my student’s
transcript
(course is
for
survey/practice only).
Transcript
Information
One (1) transcript will be mailed for each paid session; additional transcripts will be charged a fee of $7.00. Students must complete a Course
Agreement with their instruction in order to receive a grade. Students who receive a “NG”(No Grade) will NOT receive a transcript and their
Course Agreement will be filed with the Chino Valley Unified School District’s Alternative Education Department.
Email
Transcript
Mail Transcript
Pick
Up
Transcript:
Location:
Alternative
Education
Center
15650 Pipeline Ave, Chino Hills 91709
Transcript
to
be
Mailed/Emailed
to:
Parent Name or School Site:
Attention:
Address:
City:
Email Address:
Current School Counselor:
Course
Student
is
Registered
for:
Course
Name:
Semester:
Transcripts
will
be
mailed
within
2
weeks
of
the
completed
course
date.
ULV/Chino
Valley
USD
is
not
responsible
for
transcripts
that
are
lost or
stolen.
Additional
transcripts
can
be
requested
for
a
$7.00
fee
by
faxing
a
Transcript
Request
Form
to the
University of La Verne OHS office at
(909)448-1662.
Once
a
request
has
been
received
a
member
of
the
University of La Verne OHS office
staff will contact you to verify the
information and receive payment.
FOR OFFICE USE ONLY
DO NOT WRITE
BELOW THIS
LINE
Date Requested Received:
Processed By:
Date Mailed:
