Cowley County Community College Transcript Request Form
Registrar's Office
Cowley County Community College
PO BOX 1147
Arkansas City, KS 67005-1147
Fax: (620) 441-5250
Complete all seven items and return with $6.0
0 fee per copy to the above address. Fill out and print form.
Allow 5 working days for processing and mailing, except at end of term allow 2 weeks.
1. Name:
Last First Middle
2. Address:
Street Address
City State Zip
Social Security: ___________-________-____________ Home telephone No.
Daytime Telephone Number: E-Mail Address:
3. Other last name(s) used on records (example: maiden)
Date of birth:
4. Number of transcripts to be mailed to address below
A transcript request will not be processed for a student with financial or other obligations to the College.
Recipient / Company / Institution (DO NOT ABBREVIATE)
Attn:
Street Address
City State Zip
Note: Student is responsible for correct address. Transcript(s) will be mailed to the address indicated
above. If a transcript is to be sent to more than one address, use additional forms.
5. (Check one of the following)
Send now, do NOT hold for semester grades
Hold until semester grades are posted
Hold until degree statement is posted
Hold for change of grade/incomplete: Course Term
Other instructions:
6. Method of payment: Check Money Order
Select one: Discover Master Card Visa
Credit Card #
Expiration Date: Security Code:
7. Student's signature Date:
Some institutions will not accept “Issued to Student” transcripts.
Date Pd: ___________________________
Amount: ___________________________
Rec #: _____________________________
Date Transcipt mailed ________________
