For Oce Use Only
OFFICIAL TRANSCRIPT ORDER FORM
Your social security number is conﬁdential and, under a federal law called the Family Educational Rights & Privacy Act, the college will protect it from unauthorized use and/or disclosure.
In compliance with state/federal requirements, disclosure may be authorized for the purposes of state and federal ﬁnancial aid, Hope/Lifetime Learning tax credits, academic transcripts, assessments or accountability research.
In compliance with the Family Education Rights and Privacy Act of 1974, a student’s transcript will be released only upon the signed, written request of the student. TELEPHONE REQUESTS WILL
NOT BE HONORED. Ocial transcripts are printed on security paper, contain the school seal, the Registrar’s signature, and are issued in a sealed envelope. Release of transcripts to a second par-
ty requires: 1) a signed, written release from the student authorizing a second party to pick up a transcript 2) a copy of the student’s photo identiﬁcation (e.g. driver’s license), and 3) positive photo identiﬁca-
tion (e.g. driver’s license) of the party with the written authorization. Transcripts will not be released to a student’s parent unless the parent has the student’s written consent. Transcripts will not be issued if: 1) the stu-
dent’s admissions ﬁle is not complete, or 2) the student has a ﬁnancial obligation to CBC in terms of nonpayment fees or loans or failure to return College owned materials. For more information, visit columbiabasin.edu/transcripts.
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and armative action. CBC does not discriminate on the basis of race, col-
or, creed, religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the pres-
ence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be
referred to the Colleges Title IX/EEO Coordinator: Camilla Glatt, Vice President for Human Resources & Legal Aairs, 2600 N. 20th Avenue, Pasco, WA 99301, telephone (509) 542-5548, email email@example.com. Individuals with disabilities are encouraged to
participate in all college sponsored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
SECTION B: TRANSCRIPT INFORMATION
How many ocial transcripts are you ordering?
Please select an option
(Payment is required before a transcript request is processed):
q $10 per ocial transcript mailed via U.S. First Class Mail or ready for pickup within seven business days
q $30 per ocial transcript for same-day pickup (in person orders only)
When should this be processed (Check only one)?
q Process Now
q After grades posted for current quarter
q After degree is posted for current quarter (You must apply for graduation before degree will be posted)
How will you receive your transcript?
q Hold for in-person pickupq Send transcript to address in Section Aq Send transcript to address below:
Complete one transcript order form for each address
City State Zip
SECTION A: STUDENT INFORMATION
Student Identiﬁcation Number OR Social Security Number
Please print or type
Did you attend prior to 1986?
q Yes q No
Last Name First Middle
Mailing Address Street City State Zip
Birth Date Previous/Former Name(s) Phone#
Student's Signature Date
SECTION D: WHERE TO SUBMIT
In Person Email Mail
Hawk Central firstname.lastname@example.org ATTN: Transcripts
Columbia Basin College MS-H4
Pasco Campus 2600 N. 20th Ave.
Pasco, WA 99301
SECTION C: PAYMENT
Cash Check Money Order Visa MasterCard
(If using credit card, please ﬁll in information below. May be left blank if paying in person.)
Expiration date CVV
Amount $ Name on credit card
Billing address listed on card
q q q q