Co-Curricular Transcript Roster

Please complete a separate roster for each activity or entry.

Faculty or Staff Sponsor:

Date of activity, induction, etc.: FROM TO

Pick an option from the drop down menu and fill in the description on the lines below:

Please type in the name and/or brief details of the activity, award, community service, etc.

	MUST INCLUDE! Student ID #	Student Last Name	Student First Name	Student Role (ie. team member, president, presenter, attendee, recipient, etc.)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

If you have more than 50 students to include on your roster, please include the additional names below. Be sure to include the student's ID and role as well.

I understand that this information is to be completed for the use of co-curricular transcripts detailing student involvement in co-curricular activities. I hereby pledge that the above information regarding the aforementioned student's participation is accurate and complete to the best of my knowledge.

SIGNATURE of faculty or staff sponsor: Date: 05/16/2012
(Electronically sign by typing in name if sending via email)