Please clearly fill out Section 1 and Section 2. Sign and date the form.
Mail the form with the applicable fee/s to the mailing address below.
Section 1—Must be Completed by Former Test-Taker
Current Legal Name (REQUIRED, First, Middle, Last) Date of Birth (REQUIRED, month/day/year)
Name at Test Time and Any Other Names Used (Required if diﬀerent than above) Social Security Number (last 4 digits)
XXX - XX -
Current Mailing Address, City, State, Zip Code Current Phone Number
( ) -
Approximate Tesng Locaon Approximate Tesng Date
Check here to send oﬃcial transcript/s to address above.
Oficial Transcript/s Sent To...
Name of Business, Educaonal Instuon, etc. Aenon to Department, Individual, etc.
Mailing Address, City, State, Zip Code (No PO Box IF using FedEx Expedite Shipping) Business Contact Number
( ) -
Certification: “I hereby certify that all information provided is true, and I authorize the release of my official tran-
script or completion date to the requestor.” (Signature Required by FERPA Student Privacy Act)
Signature Date /
Requests are processed within 2-3 business days of receiving.
Arizona Department of Education
3rd Parties must call (602) 258-2410, option #2 to obtain verbal verification.
Adult Education Services Bin #26
NO PERSONAL CHECKS OR CREDIT CARDS WILL BE ACCEPTED.
1535 W Jefferson Street
OFFICIAL TRANSCRIPT/S WILL NOT BE SENT BY FAX OR E-MAIL.
Phoenix, AZ 85007
(Money Order or Business Check ONLY; Payable To AZ Department of Educaon; Check all that apply; USPS ﬁrst class shipping ONLY)
Transcript for years 1945 to 1984 - $15.00 (Microﬁlm Search, 1 oﬃcial transcript) Addional at $10.00 each X Quanty _______
Transcript 1985 to the Present - $10.00 each X Quanty ________
Verbal Veriﬁcaon (3rd Pares Only) 1945 to 1984 - $15.00
Verbal Veriﬁcaon (3rd Pares Only) 1985 to the Present - $10.00
Total Amount Enclosed: $____________
FedEx Expedite Shipping Options
(in addion to transcript fee/s ONLY; tracking included; signature required; No shipping to PO Boxes)
FedEx Express Overnight: $20.00
FedEx Ground, All Other AZ Cies: $4.00
FedEx Ground, Phoenix: $3.60 FedEx Ground, Out of State: $8.00
Eﬀecve and updated 12/26/2017
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