Registrar's Office
950 Main Street
Worcester, MA 01610-1477
FAX: 508.793.7548
Parent Request for Release of Grades
| Print Student Name: | _______________________ | ____________________ | ___________ |
| Last Name | First Name | Middle Initial | |
| Clark ID# | _______________________ |
I/We hereby affirm that my(our) son/daughter, currently enrolled at Clark University, is a dependent for tax purposes. I/We request that a copy of my (our) son's/daughter's grades for the coming academic year only (Fall 2008 and Spring 2009 semesters) be mailed to me (us) at the address listed below:
| ______________________________________________ | ________________________________ |
| Last Name | First Name |
| ______________________________________________ | ________________________________ |
| Last Name | First Name |
|
Address: _______________________________________________________________________ |
|
| ______________________________________________________________________________ | |
| ______________________________________________________________________________ | |
| City: _______________________________ State: _____________ Zip Code: ________________ | |
| Nation: ________________________________________________________________________ | |
| Signature of Parent: _____________________________________ | Date: ___________________ |
| Signature of Parent: _____________________________________ | Date: ___________________ |
Please Return to the Registrar's Office