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SURRY COMMUNITY COLLEGE
630 South Main Street
Dobson, NC 27017
Corporate & Continuing Education Transcript Request Form
Please forward a ( student official) copy of my CEU transcript to the following address:
Requesting Official Transcripts by mail: $3 charge per official copy – please include check or money order for the
total number of copies and make payable to SCC (driver’s license number must be included on check).
Requesting Official Transcripts by fax: $3 charge per official copy - please include credit/debit card number, type
of card, expiration date, and security code
(back of card) on this form and fax to 336-386-3691.
Forward Transcript to:
(choose one)
Student Information:
Last:
First: Middle/Maiden: Former Name:
(If name has changed)
Street Address:
City: State: Zip Code:
Telephone: Social Security # or Colleague ID#: Birthdate:
Student Signature
Date
Mail to: Surry Community College
Corporate & Continuing Education Division
630 South Main Street
Dobson, NC 27017
Request for unofficial copies may be faxed to (336) 386-3691
Official Transcript Charge
Visa
CETRA (AR Code)
Mastercard
CETRS (NARD) NonCIS Transcript
Discover
$3 per Official Copy x ____
copies
American Express
Expiration Date
For Office Use Only
Total Amount Received: ___
Security Code
Credit
Debit
-
-
-
Date Forwarded
SCC Continuing Education Staff
click to sign
signature
click to edit
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