BHP Share-Transfer Transcript Form BHP Permission to Share/Transfer Blended Curriculum Transcript Name(Required) First Last Email(Required) Last 4 of SSN #:(Required)Birthdate (mm/dd/yyyy)(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please read the following section very carefully.(Required)Please select either Option A or Option B, and complete all of the questions that follow thoroughly. To ensure that your request is processed in a timely manner, please fill out this form accurately, and contact your supervisor if assistance is needed. Option A: I am currently employed with only one agency/school, and want to transfer my BHP training transcript to that ONE organization. Option B: I am currently employed with MORE THAN ONE agency/school, and want to transfer my BHP training transcript to multiple organizations. Name of Agency/School(Required)Date of Hire(Required)Name of Agency/School 1:(Required)Name of Agency/School 2:(Required)Name of Agency/School 3:(Required)If you only have 2 agencies/schools please put N/ASignature/Consent(Required)Please type your full name to signify your permission to share this transcript with the listed parties.
