College Transcript Request Form
For Financial Aid Unusual Enrollment
History Verification (GEN-13-09)
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Please complete this form and submit it with any required fees to the previous institution when
requesting transcripts to be sent to the Northwest State Community College Financial Aid Office.
Transcripts will only be accepted when mailed directly to Northwest State from the issuing institution.
Printed Name (last, first, middle) ________________________________________________________________
All Previous Names ___________________________________________________________________________
Mailing Address _____________________________________________________________________________
City/State/Zip ______________________________________________________________________________
Social Security Number/School ID Number ________________________________________________________
Phone Number ______________________________________________________________________________
Birth Date __________________________________________________________________________________
Graduation Date or Attendance Date ____________________________________________________________
Email Address _______________________________________________________________________________
Registrar: Please attach a copy of this form to the official transcript.
Transcripts must be mailed directly to the Financial Aid Office of Northwest State
Community College.
Hand carried or faxed transcripts will not be accepted.
Mail to: Financial Aid Office
Northwest State Community College
22600 State Route 34
Archbold, OH 43502
I authorize you to release an official copy of my college transcript(s) to Northwest State Community
College.
Student Signature_________________________________________ Date________________________
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity,
disability, religion or age in its programs or activities.
