June 2012
www.southeasterntech.edu
__________________________________________________________________________________________
SWAINSBORO • 346 Kite Road • Swainsboro, Georgia 30401 • Phone (478) 289-2200 • Fax: (478) 289-2263
VIDALIA • 3001 East First Street • Vidalia, Georgia 30474 • Phone (912) 538-3100 • Fax (912) 538-3156
Southeastern Technical College is an Equal Opportunity Institution
TRANSCRIPT REQUEST FORM
Name of High School or College Attended: ______________________________________________
FOR: Student’s Name at Time of Enrollment: ____________________________________________
Social Security Number: ______________________________________
Date of Birth: _______________________________________________
Phone Number: _____________________________________________
FORWARD AN OFFICIAL* COPY OF MY:
_____ High School Transcript OR _____ College Transcript
_____ Swainsboro Campus OR _____ Vidalia Campus
(* For a copy to be official, it must have a seal, stamp, or authorized signature. If brought by the
applicant in person, documents must be in an unopened envelope, officially sealed by the issuing
school or agency.)
Dates Attended: _____________ to ___________ Graduated? Yes______ No______
If GED recipient, date of GED Test _____________________
Current Full Name: _____________________________________________________________
AUTHORIZATION FOR RELEASE OF SCHOOL RECORDS
I do hereby consent to the release of any information pertaining to my scholastic records and/or activities
which
(Name of Institution)_________________________________________________ may provide to
Southeastern Technical College.
I accept responsibility for any charges for transcripts. Please bill me at:
Mailing Address:
___________________________________________________________________________
Student Signature: ___________________________________ Date: __________________
