2600 N. 20th Ave.
Pasco, WA 99301
Official Online 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.
Student Identification Number OR Social Security Number
SECTION A: STUDENT INFORMATION
Did you attend prior to 1986?
q Yes
For Office Use Only
______________________________________ Processed by ______________________________________
Please print or type
q No
Last Name First Middle
Mailing Address Street City State Zip
Birth Date Previous/Former Name(s)
Phone#
Student's Signature Date
SECTION B: TRANSCRIPT INFORMATION
How many official transcripts are you ordering? _________
ocessed.
When should this be processed? (Check only one)
q
· $10 per official transcript mailed via U.S. First Class Mail or ready for pickup within seven business days. Payment is required
before a transcript request is pr
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 pickupq Send transcript to address in Section Aq Send transcript to address below:
Complete one transcript order form for each address
Name ____________________________________________________________________ Dept. ___________________
Address ___________________________________________________________________________________________
City __________________________________________________________ State __________ Zip _________________
SECTION C: PAYMENT
q Visa q MasterCard
Please fill in information below.
Credit card#: _____________________________________________________________________________ Expiration date: ___________________CVV:______
Amount: $___________________________ Name on credit card: _____________________________________________________________________________
Cardholder’s signature: _________________________________________________________________________________________________________________
Billing address listed on card _______________________________________________________________________________________________________
_______________________________________________________________________________________________________
SECTION D: WHERE TO SUBMIT
Email
transcripts@columbiabasin.edu
POLICIES
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.
Official 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 party 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 identification (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 student’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 afrmative action. CBC does not discriminate on the basis of race, color, creed, re-
ligion, 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 presence of any sen-
sory, 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 Col-
leges Title IX/EEO Coordinator: Camilla Glatt, Vice President for Human Resources & Legal Affairs, 2600 N. 20th Avenue, Pasco, WA 99301, telephone (509) 542-5548, email cglatt@columbiabasin.edu. 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.
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