__________ ______________________________________________
_______________________________________________________________________________________________________
______________ _____________ ______________ __________________
TRANSCRIPT REQUEST FORM
Continuing Education Division
Lenoir Community College
P.O. Box 188 | Kinston, NC 28502-0188 | 252.527.6223
Occupational Extension Fax: 252.233.6880 | Public Safety Fax: 252.233.6885
Transcripts may also be requested online at http://www.studentclearinghouse.org/
Student’s Signature
Student Information
Student Full Name:
Last name while enrolled, if different:
Student ID / last 4 of SS#:
Date of Birth:
Address:
City/State/Zip:
Phone Number:
Copies Requested (Check One):
Mail official transcript to:
College/Department:
Contact Name:
Address:
City/State/Zip:
Fax or e-mail unofficial transcript to:
College/Department:
Contact Name:
Fax Number:
E-mail Address:
Date
1
2
THERE IS A $5.00 FEE PER TRANSCRIPT
OFFICE USE ONLY
Request Date Fee Paid Paid Date Transcript Printed
Revised 10/2019
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome