LEO-E&T/PSS-100 (06/2020)
Michigan Department of Labor and Economic
Opportunity - Employ
ment & Training
P.O. Box 30726, Lansing, MI 48909
517-335-4000
www.michigan.gov/pss
FOR OFFICE USE ONLY
Approved By:
Date Approved:
License Number
TRANSCRIPT REQUEST
CLOSED MICHIGAN PRIVATE POSTSECONDARY SCHOOL
AUTHORITY: 1943 PA 148
PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF YOUR REQUEST
STUDENT'S INFORMATION
FOR OFFICE USE ONLY - VALIDATION
Make your check or money order in U.S. Currency payable to:
STATE OF MICHIGAN
FEES ARE AUTHORIZED BY 1943 PA 148
FOR OFFICE USE ONLYFEE PAYMENT INFORMATION (Check Appropriate Box)
LEO-E&T is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to
individuals with disabilities.
Student's Name Last 4 digits of Social Security Number
Address
Telephone Number Year of Birth E-mail Address
City State ZIP Code
Other name(s) student may have used: Name and Address to Mail Transcripts to:
School Attended Dates Attended
School Location/Address
VERIFICATION AND SIGNATURE
I understand the enclosed fee is non-refundable and is payable for the records search even if my transcript is not on file.
I understand there is no guarantee that my transcript will be located.
I authorize the State of Michigan to release my transcript to the above stated address(es).
Signature Date
Private Post secondary School Transcript from a:
In-State Accredited School
In-State Non-Accredited School
Out-State Accredited School
Out-State Non-Accredited School
Fee: $26.00
Fee: $26.00
Fee: $26.00
Fee: $26.00
8601-51 = $26.00
8604-51 = $26.00
8602-51 = $26.00
8605-51 = $26.00
