HIGH SCHOOL TRANSCRIPT REQUEST FORM
Instructions: Please complete this form and submit it to your previous high school records
office, with the appropriate fee, (if applicable). You will need to contact your previous high
school records office to discover the amount of the fee (if applicable). If the high school from
which you graduated and/or are seeking to receive your transcript is no longer in operation,
contact the Department of Education of the state in which the high school was located. Your
signature on this completed form is authorization to release and mail an official copy of your
transcript to Columbus State Community College.
PLEASE PRINT
Name:____________________________ _______________________ _______ ____________________
LAST FIRST MI PREVIOUS LAST NAME
Date of Birth (mm/dd/yyyy):_____/____/________ Social Security Number:_______/_____/_______
Graduated (mm/yy): _______/_____ Will Graduate (mm/yy): ______/_____
Withdrew _____/_____
Current Address:_____________________________________________________ _________
STREET APT NUMBER
______________________________________ _________ _________
CITY STATE ZIP CODE
High School:_____________________________________________________________________
NAME OF HIGH SCHOOL
_____________________________________________________________________
STREET ADDRESS
__________________________________________ ________ _________
CITY STATE ZIP CODE
I authorize an official copy of my Hi
h School transcript to be released and mailed to Columbus State
Community College.
Signature of Applicant:_____________________________________ Date:_____/_____/_____
Signature of Guardian:_____________________________________ Date:_____/_____/_____
(If student is under 18 years of age)
PLEASE MAIL TRANSCRIPTS TO:
COLUMBUS STATE COMMUNITY COLLEGE
ATTN: High School Transcripts
P.O. Box 1609
Columbus OH 43216
DO NOT FAX TRANSCRIPT. COLUMBUS STATE COMMUNITY COLLEGE DOES NOT ACCEPT FAXED TRANSCRIPTS
RLR:prc/High School Transcript Request Form/08-26-2019
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