Clark University

Registrar’s Office
950 Main Street
Worcester, MA 01610-1477
FAX: 508.793.7548

Student Request for Release of Grades

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If you wish to have your parents or a third party receive a copy of your semester grades, please print and fill out this form and return to the Registrar’s Office.

 
Student Name: __________________________________________________________
 
Clark ID# ____________________________________________________________

_____ Parent or guardian

_____ Outside Scholarship Agency

_____ Other

Name and address of third party(s):

 
1) _____________________________________________________________________
 
 _____________________________________________________________________
 
 _____________________________________________________________________
 
 
2) _____________________________________________________________________
 
 _____________________________________________________________________
 
 _____________________________________________________________________
 

I authorize the Registrar's Office to send to the above third party(s) reports of my grades for the coming academic year only: Fall 2008 and Spring 2009 semesters.

 
Signature ______________________________________________
 
Date ___________________________________________________