ke0719
REQUEST FOR TRANSCRIPT OF RECORD
($5.00 charge per mailed copy, $12.00 charge per unofficial faxed copy)
(Cash, Check Debit/Credit Card Accepted)
911 South Tenth Street, Tucumcari, NM 88401
(575) 461-4413 Phone (575) 461-1901 Fax
PLEASE PRINT
Student Name
SSN
Current Address
Date of Birth
City/State/Zip
Number of Copies
Phone
Date of Request
Applicant is responsible for address
MAIL TO:
Dates attended
Date completed
Student Signature
Send Immediately
YES
NO
Hold for Current Grades
YES
NO
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