ACADEMIC TRANSCRIPT

STUDENT’S NAME

CITY

COUNTRY

SCHOOL
(NAME OR NUMBER)

SCHOOL TELEPHONE

Please complete this form for the 2016-2017 and 2017-2018 school years. You will bring this completed form with you
to the United States. Show it to your American high school guidance counselor to help you select the courses you will
take in the United States. Please make additional copies of this form if necessary.

YEAR SUBJECT COURSE DESCRIPTION TOTAL HOURS FINAL MARKS

(per academic year )
Example:
2016- Chemistry Oxygen and sulphur. Nitrogen and phosphorus. Carbon 68 10
2017 and silicon.

School director __________________________________________ signature ________________ date ____________ school stamp

(Last name, first name, middle name)
 YEAR SUBJECT COURSE DESCRIPTION TOTAL HOURS FINAL MARKS
(per academic year )

School director __________________________________________ signature ________________ date ____________ school stamp

(Last name, first name, middle name)