Coastal Carolina Community College
Request for Transcript or Placement Test
(no fee required)
First Name
MI
Last Name
Name used when registered if different from above:
Student Information (All financial obligations must be satisfied before processing.)
Date Requested
Date of Birth
TelephoneSocial Security #
Is this transcript:
Curriculum (credit) Courses Continuing Education (non-credit) Adult High School or
Number Requested
Student Signature:
Date Transcript Processed
Office Use Only
Send completed form to:
Coastal Carolina Community College -Registrars Office
444 Western Boulevard
Jacksonville, NC 28546
Fax: (910) 455-2767
OR Student ID
Year Attended
(e.g. 2005)
Do you want:
Official Transcript
Student Transcript
Number Requested
Should we:
Issue transcript now
Hold for term grades
(end of semester)
Delivery Method (please select one)
College or
Recipient Name:
City:
Zip
State
Pick Up - Photo ID (student ID, drivers' license,
etc.) is required to pick up your transcript
Someone else to pick up
transcript. If so who?
Mail transcript to the college, university,
or individual listed below
Name:
College or
Recipient Name:
Address 1: Address 1:
Address: Address:
City:
State:
Zip
If you are picking up transcripts, they must be picked up within thirty (30) days.
GED COMPASS/ASSET Test
Revised 10/13
Fax unofficial transcript
Fax Number: Recipient Name:
