Transcript Request Form
Registrar’s Office
1555 Newark Road
Zanesville, OH 43701
(740) 588-1273 Fax: (740) 454-0035
Instructions: Please complete a separate form for each “send to” request. Your transcript(s) will not be released if you have a financial obligation to Zane State College.
Name: _____________________________________________ Social Security # ________________________
Name Last Registered Under: _____________________________ Date of Birth: _________________________
Address: ___________________________________________________________________________________
City: __________________________________________ Zip: __________ Phone:______________________
Program(s) of Enrollment |
Undergraduate |
Post-Secondary |
Currently Enrolled? |
Yes |
No |
Dates of Attendance: _______________________________________________ |
Number of Transcripts Requested: ___________ at $5 each ________ (This fee must be paid before a transcript is processed.)
Credit Card #: ____________________________ Credit Card Type: _________ Expiration Date: ____________
Reason for Transcript Request: |
Transferring to another institution |
Entering the military |
|
Need for potential employment |
Other _________________ |
Signature: __________________________________________________________________________________
Instructions: Please tell us how to process your transcript by checking as many boxes as appropriate. Transcripts will be processed within 5 business days of receipt of request.
Send to my mailing address on file.
Hold transcript for pick-up, I understand that I must present a photo ID to receive the transcript. Release transcript to _____________________________________________________________
I understand that he/she must present photo ID to receive transcript
Fax transcript to the individual and number shown below. All faxed transcripts are unofficial. Mail transcript to the address shown below:
As soon as possible
After the grade submission deadline for the current semester has passed
After graduation
|
Send Transcript to: |
For Office Use Only |
|
______________________________________________ |
|
|
|
______________________________________________ |
Prepared by:__________________ |
|
|
|
______________________________________________ |
Date mailed/faxed: _____________ |
|
|