Fillable Transcript Request For Official Use Only (Clatsop Community College)

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Transcript Request For Official Use Only (Clatsop Community College)

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PLEASE NOTE- Transcripts will not be released if:
_________________________________________________________ ____________________________________________
CCC Student ID# Date of Attendance
___________________________________________________________________________________________________________________________________________________________________________________
Last Name First Name M.I. Date of Birth
___________________________________________________________________________________________________________________________________________________________________________________
Mailing Address City State Zip
________________________________________________________ _____________________________________________________________
Telephone Email
Submit Completed Form:
In Person:
Mail:
Email:
When do you want your transcript processed?
Immediately
Hold for Final Grades
Hold for Degree
Print clearly, in the space below, the complete name and address of where you want your transcript sent.
Check this box if transcript mailing address is the same as above
Institution Name:
Contact/Dept. Name:
Mailing Address:
City, State, Zip:
You must sign this form before your request can be processed.
_______________________________________________________________ ______________________________
Signature Date
For Official Use Only
Payment Information
Make check / Money Order payable to: Clatsop Community College
Cash
Visa/MasterCard Discover # ________________________________________Expiration__________CVV#_______
Transcript Request
Non-Discriminaon Declaraon
It is the policy of Clatsop Community College that there will be no discriminaon or harassment on the grounds of race, col-
or, sex, gender, marital status, religion, naonal origin, age, sexual orientaon, gender identy or expression or disability in
any educaonal programs, acvies, or employment. Quesons or complaints should be directed to Desiree Noah, Arma-
ve Acon/Gender Equity (Title IX) Ocer, Lower Library, Suite 103, dnoah@clatsopcc.edu 503-338- 2450; TDD 503-338-
2468. The Director of Student Access Services, Mallory Vollner, is in Columbia Hall, Suite 111, mvollner@clatsopcc.edu 503-
338-2474.
Accommodaons
Persons having quesons about or a request for special needs and accommodaon should contact JoAnn Zahn, Vice Presi-
dent of Finance and Operaons, at Clatsop Community College, 1651 Lexington Avenue, Astoria, Oregon 97103, Lower Li-
brary Suite 110, jzahn@clatsopcc.edu Phone (503) 338-2421 or TDD (503) 338-2468. Please send special needs and accom-
modaons requests here. Contact should be made at least two business days in advance of the event.
Declaración de no-discriminación
Es la políca de Clatsop Community College que no habrá ningún po de discriminación o acoso por razón de raza, color,
sexo, género, estado civil, religión, origen nacional, edad, orientación sexual, idendad de género o expresióno discapacidad
en los programas educavos, acvidades o en la contratación. Preguntas o quejas deben ser dirigidas al Desiree Noah, Ocial
de Acción Armava / Título IX localizado en Library número 103 dnoah@clatsopcc.edu número de teléfono 503-338-2450,
TDD (discapacidad audiva) 503-338-2468. Director de Servicios de acceso para estudiantes, Mallory Vollner, se encuentra
en Columbia Hall, numero 111, mvollner@clatsopcc.edu número de teléfono 503-338-2474. Para ADA y otras peciones de
servicios llame al 503-338-2474 o para TDD (discapacidad audiva) 503-338-2468.
Ayuda a personas discapacitadas
En cuanto a las personas discapacitadas, se les pide que se comuniquen con JoAnn Zahn, la Vice Presidente de Finanzas y
Operaciones en Clatsop Community College, 1651 Lexington Avenue, Astoria, Oregon 97103, Library Suite 110,
jzahn@clatsopcc.edu número teléfonico (503) 338-2421 o a TDD (503) 338-2468. Haga el favor de nocar a la ocina para
que se le pueda proporcionar apoyo. La comunicación debe tomar lugar por lo menos dos días de trabajo antes del evento
por el cual se requiera tal ayuda. Para más información, vea la página Web de Clatsop Community College bajo Información
en Español.
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Transcript Request For Official Use Only (Clatsop Community College)

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Completed 4 February 2021

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