Request For Transcripts / Statement Of Grades Form

For Office Use Only:

Record Number

Columbia College

Request for Transcripts / Statement of Grades Form

Statement of Grades – No Charge

Unofficial - $5.00 per copy

Official - $10.00 per copy

Official transcripts are mailed from the Registrar’s Office to the person/address named by the student.

1.

Hold for Pick Up

2.

Transcripts/Statement of Grades will be released to a third party only on presentation of written authorization

from the student.

Mail Immediately

3.

Columbia College shall not be held responsible for meeting deadlines which are not those of Columbia

College.

Hold for Final Semester

Transcripts/Statement of Grades are issued in the ‘last name of record’ at Columbia College. Requests to

4.

change a name must be supported by an attached copy of an official ‘government issued’ document, for

Grades

example, a driver’s license, birth or marriage certificate, etc.

5.

Transcripts/Statement of Grades are normally produced in three to five business days.

Print your name and address clearly.

Last Name

First Name

Address

City

Province

Country

Postal Code

Personal Information

Student ID Number

Date of Birth

Former Name (If applicable)

(Area Code) Home Telephone

(Area Code) Business and/or Cell Phone Number

E-mail Address

Indicate most recent Program and year you attended

Program

Year

Request #1

Request #2

Name of University or College or Person to whom transcript

No. of Copies

Name of University or College or Person to whom transcript

No. of Copies

/statement of grades is to be sent.

/statement of grades is to be sent. (If different from Request #1)

Office

Office

Street Address

Street Address

City

Province

City

Province

Country

Postal Cole

Country

Postal Code

Fees

Name of Cardholder

VISA/MasterCard#

Expiry Date (mm/yy)

Total Fees

$

Payment received by other method:

Debit

Cash

Money Order

Student Signature

Signature

Date

The personal information collected on this form has been collected for the sole purpose of processing your request. The information is collected in accordance with the

Columbia College privacy policy, as well as Alberta Personal Privacy legislation. If you have any questions about the collection or use of this information, please contact the

Corporate Privacy Officer at (403) 235-9300. This form must be signed before we can process your request.

A transcript/statement of grades will not be issued if you have outstanding accounts with

Columbia College.

Document Name: Request for Transcript/Statement of Grades Form

Approval Date: May 20, 2009

Document Number: REG-F008

Approved by: Patrick Simmons

NOTE: Revisions to this document can be made following procedures outlined in Document #ADM-P014 – Document Control Policy and Procedures

Revision #3

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