TRANSCRIPT REQUEST
(Note: Requests for transcripts related to the Adult Practical Nursing, Nurse Assistant or other adult health careers
programs must be accompanied by a payment of $5 in cash or money order: no personal checks accepted.)
Name: __________________________________________________________________
Date of birth: _____________ Other names used:_______________________________
Current address: _________________________________________________________
City __________________ State _____________________ Zip ____________________
Telephone: ________________ E-Mail: _____________________________________
Year of Graduation: _______________ Program completed: _______________
PLEASE FORWARD AN OFFICIAL TRANSCRIPT TO:
Name of college/school/business: ___________________________________________
Attention: ______________________________________________________________
Address: _______________________________________________________________
_______________________________________________________________
Signature: ________________________________________ Date: ________________
Please return payment and Transcript Request form to:
Health Careers c/o Bursar
1015 Watervliet-Shaker Rd.
Albany, NY 12205
Office Use
Official Coy sent:
Unofficial copy sent to student (upon request only):
Receipt # ____________________
If you need the assistance of an interpreter, need material translated into any language other than English, please call Ottavio Lo
Piccolo at (518) 862-4703 and leave a voice message. Thank you. Si usted necesita asistencia de un interprete, o necesita traducion
en espanol, y otros idiomas, por favor llame a Ottavio Lo Piccolo a este tel. (518) 862-4703, y deje un mensaje de voz. Gracias
The Capital Region BOCES does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs, activities,
employment, and admissions; and provides equal access to the Boy Scouts and other designated youth groups. The following person has been
designated to handle inquiries regarding the non-discrimination policies: Robert Zordan, compliance officer/coordinator, at
robert.zordan@neric.org, (518) 862-4910 or 900 Watervliet-Shaker Road, Albany, NY 12205. Inquiries concerning the application of the Capital
Region BOCES non-discrimination policies may also be referred to the U.S. Department of Education, Office for Civil Rights (OCR), 32 Old Slip, 26th
Floor, New York, NY 10005, telephone (646) 428-3800 (voice) or (800) 877-8339 (TTY).
ALBANY | SCHOHARIE | SCHENECTADY | SARATOGA | Board of Cooperative Educational Services
Career & Technical School – Albany Campus
1015 Watervliet-Shaker Road, Albany, NY 12205 • (518) 862-4800 • www.capitalregionboces.org/careertech
An Equal Opportunity Employer
