REQUEST FOR TRANSFER OF CREDIT FORM
Your social security number is confidential and under a federal law called the Family Educational Rights & Privacy Act (FERPA), the college must protect it
from unauthorized use and/or disclosure. In compliance with state/federal requirements, disclosure may be authorized for the purposed of state and federal
financial aid, Hope/Lifetime Learning tax credits, academic transcripts, assessment or accountability research.
This form is required for transfer of college level courses. Any applicable program coursework will be sent by the
Credentials Evaluator to the program instructor for evaluation.
Step 1: Complete the form below and submit to Enrollment Services in Bldg. 17, Room 130
Social Security # ________________________________ Student ID # (If applicable) _______-______-__________
Student Name ___________________________________________________________________________________
Last Name First Name Middle Initial
Previous Last Names _________________________________________ ______________________________________
Last Name First Name
Mailing Address ___________________________________________________________________________________
P.O. Box or Street Apt Number or Unit
___________________________________________________________________________________
City State Zip Code
Email address: ___________________________________________________________________________________
Contact Number(s): ________________________ _____________________ Birth date: _______/______/__________
Preferred Contact Number Alternative Contact Number
CPTC Program Title ____________________________________________________________________________________
Step 2: You will need to contact the college you attended and request an Official Transcript be sent
to CPTC to the address or email address for electronic transcripts below:
Official Transcripts being submitted by the student must be sealed by the college or institution.
Opened transcripts will be considered unofficial and cannot be used for transfer of credits.
Mailing Address: Enrollment Services Office Email: evaluator@cptc.edu
Clover Park Technical College
4500 Steilacoom Boulevard SW
Lakewood, WA 98499-4098
Name of colleges that your official transcripts are coming from:
Date transcript submitted/
requested to be sent to CPTC:
Student Questions/Comments:
Signature
Date
______________________________________
________________________
