Name:_______________________________________________________________
Last First MI
Address: _____________________________________________________________
City/State/Zip: _________________________________________________________
Phone:____________________________ Alternate Phone: _______________________________
Note: Please ensure that your information is legible and your complete address is included.
Authorizations that are incomplete will not be accepted and will delay your transcript pick up.
Transcript Authorization Release Section
(Please read carefully and ensure all required information is included)
I, _______________________________________ authorize _____________________________
to pick up my ofcial transcript from the Admissions & Records ofce at Napa Valley College. I under-
stand that this designee will need to have proper identication with them at the time of pick up. I also
understand that if this designee does not have proper identication with them at the time of pick up,
Admissions & Records will not release my transcript. I further understand that this designee will have
access to my personal information and I release Napa Valley College from all responsibility and/or
liability in the event that my information is misused.
Student Signature: ____________________________________________ Date: ______________
Transcript Designee Signature:__________________________________ Date: ______________
Admissions and Records
2277 Napa-Vallejo Highway, Napa, Ca. 94558
707-256-7200 fax 707-256-7219
Transcript Authorization of Release
Please print clearly in black or blue ink. All blanks must be lled-in for this form to be considered.
NVC Student ID#
(7 digit number assigned by the college for identication)
REv. 5/22/2015
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