Student ID#: (if known) ___________________
Last Name: ____________________________________ First Name: _______________________________ Middle Initial: ________
Mailing Address: ______________________________________________________________________________________________
City: __________________________________________________________ State: ____________ Zip Code: ___________________
Any Previous Names: ______________________________________________________________________
Date of Birth: ______________________________ Last 4 Digits of Social Security Number: _____________
Best Telephone Number for Contact: ________________________________________
Unofficial transcripts are provided free of charge and mailed only to the student as
long as there are no unmet obligations to the College.
Unofficial transcripts will be mailed within 5 business days to the student address
provided and cannot be emailed or faxed.
Records prior to 1993 may take up to 10 business days to process prior to mailing.
2240 Iyannough Road West Barnstable, MA 02668
774.330.4387 Fax: 508.375.4084
In accordance with the Family Educational Rights Privacy Act of 1974 (FERPA), I authorize, with my signature,
the release of my student records as well as authorize CCCC to update my Directory Information.
Signature Required: ______________________________________________________ Date: _______________
(Physical signature only; typed signatures are not accepted)
For Office of the Registrar Use Only
Holds: ____________ Copies __________
Completed Date: ________________ Initials: ________
Revised 01/2020