Transcript Request Form printable pdf download

Transcript Request Form

Today’s Date: ________________ Number of Official Copies: ________ Student ID # or SSN : _________________________________

Student’s Name Last : __________________________________________ First: _______________________________ Middle Initial: ____

Maiden or other Name: _________________________________________ Home Phone #: _______________________________________

Address: ____________________________________________________ City: ________________________ State: _____ Zip: ________

Email Address: ___________________________________________________________________________________________________

Date Last Attended (Semester/Year): ______________________________ Date Graduated (Month/Year): __________________________

Type of Transcript Requested: _______Adult High School only

______ Combined (Curriculum/Continuing Education)

Hold for Current Semester Grades:

Yes: _______

No: ________

Hold for Degree Posted: Yes: ______

No: _______

Student’s Signature (Required): ___________________________________________________________________

________(#) official copies to be mailed to:

School/Business/Person: ____________________________________________________________________________________________

Attn: ____________________________________________________________________________________________________________

Street Address/PO Box: _____________________________________________________________________________________________

City/State/Zip: ___________________________________________________________________________________________________

________(#) official copies to be mailed to:

School/Business/Person: ____________________________________________________________________________________________

Attn: ____________________________________________________________________________________________________________

Street Address/PO Box: _____________________________________________________________________________________________

City/State/Zip: ___________________________________________________________________________________________________

________(#) official copies to be mailed to:

School/Business/Person: ___________________________________________________________________________________________

Attn: ___________________________________________________________________________________________________________

Street Address/PO Box: ____________________________________________________________________________________________

City/State/Zip: __________________________________________________________________________________________________

To Mail this request:

Send Check or Money order for $5.00 per official transcript to: Student Records Office, CPCC , PO Box 35009,

Fax

Charlotte, NC 28235 (Make Payable to CPCC) Or

completed form to (704) 330-6007 and complete Credit Card Information below:

Amount ($5.00 per Official transcript): $ ________________ Card Type (Circle one):

Visa

Master Card

Credit Card Number: _______________________________________ Expiration Date: ______________ V-Code from back: ________

Transcript Request Form