High School Transcript Request Form

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H
S
T
R
F
IGH
CHOOL
RANSCRIPT
EQUEST
ORM
Instructions: Please complete this form and submit it to your previous high school records
office, with the appropriate fee, (if applicable). You will need to contact your previous high
school records office to discover the amount of the fee (if applicable). If the high school from
which you graduated and/or are seeking to receive your transcript is no longer in operation,
contact the Department of Education of the state in which the high school was located. Your
signature on this completed form is authorization to release and mail an official copy of your
transcript to Columbus State Community College.
P
P
LEASE
RINT
Name:____________________________ _______________________ _______ ____________________
LAST
FIRST
MI
PREVIOUS LAST NAME
Date of Birth (mm/dd/yyyy):_____/____/________
Social Security Number:_______/_____/_______
Graduated (mm/yy): _______/_____
Will Graduate (mm/yy): ______/_____
Withdrew _____/_____
Current Address:_____________________________________________________
_________
STREET
APT NUMBER
______________________________________
_________
_________
CITY
STATE
ZIP CODE
High School:_____________________________________________________________________
NAME OF HIGH SCHOOL
_____________________________________________________________________
STREET ADDRESS
__________________________________________
________
_________
CITY
STATE
ZIP CODE
I authorize an official copy of my High School transcript to be released and mailed to Columbus State
Community College.
Signature of Applicant:_____________________________________
Date:_____/_____/_____
Signature of Guardian:_____________________________________
Date:_____/_____/_____
(If student is under 18 years of age)
P
M
T
T
:
LEASE
AIL
RANSCRIPTS
O
COLUMBUS STATE COMMUNITY COLLEGE
Office of the Registrar
550 East Spring Street
Columbus OH 43215
D
N
F
T
. C
S
C
C
D
N
A
F
T
O
OT
AX
RANSCRIPT
OLUMBUS
TATE
OMMUNITY
OLLEGE
OES
OT
CCEPT
AXED
RANSCRIPTS
RLR:prc/High School Transcript Request Form/09-22-2015

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