Form 48905 - Request And Authorization For Release Of Student Records - Indiana Commission On Proprietary Education

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REQUEST AND AUTHORIZATION FOR
RELEASE OF STUDENT RECORDS
State Form 48905 (5-98)
I, _______________________________________________ hereby, request and authorize the Indiana Commission on Proprietary
Education to release a copy of my official student transcript to each person or place named below.
List full name, address, and / or fax number of the party who is to receive the transcript including your name and address if you wish to
receive a copy, also.
To locate your student record the following information is required:
Student name at time of attendance:
Social Security number:
Birthdate:
School attended:
Location of school:
Dates attended:
Course or program name:
Your current address:
Telephone number: (work)
(home)
Signature required for release:
Signature of requestor
Date
Mail or Fax your Transcript Request to:
INDIANA COMMISSION ON PROPRIETARY EDUCATION
302 WEST WASHINGTON STREET, ROOM E201
INDIANAPOLIS, IN 46204
TELEPHONE NUMBER: (317) 232-1320, or TOLL FREE IN STATE 1-800-227-5695
FAX NUMBER: (317) 233-4219
NOTE: A transcript is considered official only when sent directly from this agency to the designated institution or employer.

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