Civil Engineer School
Transcript Request Form
PRIVACY ACT STATEMENT: The following information is provided as required by the Privacy Act of 1974 authorized by 10 USC 8012.
In order to process this application, we must ask for a Social Security Account Number if you are a US Citizen. Even though not required, it will help in expediting this
application; however, failure to provide the information will result in the designated agency not receiving transcripts as requested by the student.
elephone: Comm (937) 255-5654 DSN 785-5654
Fax: Comm (937) 255-4645 DSN 785-4645
2950 Hobson Way
WPAFB, OH 45433-7765
Complete and return to the above email or address. If not filling out this form online, make sure that you print legibly.
1. Personal
First Name Last Name Middle Name/Initial Maiden Name or Other Name
SSN or Student ID# Daytime Phone Number Date Of Birth Email Address
2. Permanent
Address 2 City State Zip
3. Course
Please complete the following for EACH course:
Course Title:
Course Number:
Dates course was taken:
Where was course taken?
Was this a seminar?
Yes No
Note: Any additional information you are able to provide will be of great assistance in processing this request.
4. Send Transcript
Number of transcripts being mailed to the address below:
Address City State Zip
5. Brief Student Comments and Mailing
6. Signature and Date: Transcript request without signatures cannot be processed. Electronically sign and email or ink and
Signed By
Current Date
click to sign
click to edit