Transcript Request Form
Fill in a separate form for each addressee.
Official Transcripts
Unofficial Transcripts
Student’s
Name
and
Address
Name (Last) (First) (M.I.) (Maiden and/or other)
Address (Number & Street)
Daytime Telephone #
Mail Transcripts:
In separate sealed envelopes
(City)
(State)
(Zip)
Currently Enrolled?
(___) Yes
Hold for grades until end of current semester
Date of
Birth
Month Day Year
Student ID or Social Security Number:
(___) No
Hold for degree posting
Send
Transcript
To:
Print
Clearly
Dates of Attendance:
(___) Undergraduate: (___) Graduate
No transcript of a student’s record will be furnished to any student or
alumnus/a whose obligations to the university has not been satisfied.
I hereby authorize CCSU to release official copies of my academic
record to the person or institution named at the left.
Date
Student’s Signature
Falsifying a student’s signature is a violation of FERPA regulations.
Reason for transcript request:
Transferring to another college
Applying to graduate school
Planning to take a course at another college
Employment
Other (please specify):
PLEASE NOTE: Please mail, fax or drop off this completed form to the Registrar’s Office at the address below.
Deliver transcript request to:
Central Connecticut State University
Office of the Registrar, Davidson Hall 116
1615 Stanley Street
New Britain, CT 06050-4010
Fax: 860-832-2250