Request for High School Completion Transcripts Form
Please Complete, Print and Fax or Email
First Name* _______________________________________________________ Middle Initial ______
Last Name*
_________________________________________________________________________
Former Name(s) _________________________________________________________________________
Address 1* _________________________________________________________________________
Address 2 _________________________________________________________________________
City* _____________________________________ State* _________ Zip* ________________
Day Phone*
______________ - ____________ - ____________
SSN*
_____________ - ___________ - ___________ OR Coyote Tracks ID#: __________________
Date of Birth*
____________ / ____________ / ____________ MM/DD/YYYY
If you would like the transcript sent to you at the above address, please check here:
Send Official Transcript To:
College/University
Address 1*
Address 2
City* __________________________________________ State* ________ Zip*
Signature: Date:
I attended CMC: _____ My last year of attendance was: _________________
_____ Now. I am currently enrolled at CMC.
Number of Official Transcripts Requested:
____ Regular Request 10-14 business days
Unofficial High School Completion Transcript (Free) 3-5 business days
You may choose to have your unofficial transcript emailed OR faxed to you:
Fax # (Unofficial Transcript Only) OR
Email:
Mail: Copper Mountain College Fax:
760-366-5259 Questions: 760-366-3791, ext. 4246
Student Success Center Email:
ssc@cmccd.edu
HS Completion Transcripts
P.O. Box 1398
Joshua Tree, CA 92252 REV 08/13
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