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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)
Name/Institution:
Street Address:
City:
State:
Zip Code:
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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