We require all elds to be completed.
Name and present address of student. (Please print.)
We are not responsible for the actual delivery of transcripts issued to student.
COMPLETE ONE REQUEST FOR EACH ADDRESS TO WHICH TRANSCRIPT
IS TO BE SENT.
Request to be picked up? Yes No Date
Transcripts not picked up within 90 days will be mailed to the student’s provided address.
PLEASE SEND TRANSCRIPT TO: (Faxed transcripts are not guaranteed legible.)
Applicant is responsible for address. B,#(.5*&#(&38C
AUTHORIZATION FOR RELEASE OF CONTINUING EDUCATION TRANSCRIPT
No. of Copies
Signature of Student SSN/Student ID No.
Name as it appears on Record (Please print.) Date of Birth
Student’s Phone No.
THERE IS A $2.00 FEE PER TRANSCRIPT (NO CHECKS ACCEPTED)
OFFICE USE ONLY
Request Date Fee Paid Paid Date
PLEASE ALLOW 24-72 HOURS FOR PROCESSING
WAYNE COMMUNITY COLLEGE
Transcripted MailedProcessed By & Date