MCC-613 Equal Opportunity College/Affirmative Action Employer Rev. 11/15
Request for Transcript
ATTN: __________________________________________________________________________________________________________________________
(Name of high school, state GED office, college or testing office)
Type of Transcript Requested
High School
College
CPT (please note that scores are accepted from CPCC, Caldwell CC & T1, Surry CC and Forsyth CC only)
GED Certificate and Test Scores* Year Tested _______________________ Location ____________________________________
For GED tests taken in NC: Fax requests to GED Administrator, NC Community College System, 5024 Mail Service
Center, Raleigh, NC 27699-5024.
Please send an official transcript of my record to the address shown below. To be official, the transcript MUST be sent in a
sealed envelope. High school transcripts must indicate graduation date. Attach this form or a copy of this form to my
transcript to ensure proper identification.
Law Enforcement Training Center
Mitchell Community College
701 West Front Street
Statesville, NC 28677
Student’s Full Name ____________________________________________________________________________________________________________
Name under which enrolled (if different from above) __________________________________________________________________________
Social Security Number __________________________________________ Birthdate ___________________________________________________
Current Address (city, state, zip) ________________________________________________________________________________________________
Dates of Attendance _____________________________________________________ Graduation Date __________________________________
Student Signature _______________________________________________________________________________________________________________
Date Requested _________________________________________________________________________________________________________________
Please Note: Most colleges and some high schools charge a fee to process transcript requests. Check with your school for the
appropriate fee which must be enclosed with this request form.
