Connors State Transcript Request Form – Fill Out and Use This PDF

Official Transcript Request Form

	Office of Admissions
	Route One Box 1000
	Warner, Oklahoma 74469
Telephone: 918.463.2931	FAX: 918.463.6227

All official transcripts are issued through the Office of the Registrar on the Warner Campus of Connors State College. UNOFFICIAL transcripts are available on our website through our student SIS system. Former students must present a valid picture ID for identification if picking up a transcript in person; current students must provide their CSC student

ID card. No one else is eligible to pick up a student transcript unless this office has received the request in writing, with the person’s name picking up the transcript, date and student’s signature. In keeping in compliance with FERPA,

Connors State College does not fax official or unofficial transcripts. If there is a hold on the account and/or unpaid balance, the request will not be processed until the account hold is satisfied.

LDA:______________

Complete all information below. Please print legibly in ink.

Name___________________________________________________________________________________________________

LAST NAMEFIRST MIDDLEMAIDEN OR OTHER

Permanent Address_____________________________________________________________________________________

	STREET	CITY	STATE	ZIP CODE
Contact Telephone: (	) _____________________ E-mail address________________________________________

Social Security or Connors State College issued student identification number. ___________________________

Date of Birth: _____________________________	Are you currently enrolled at CSC?		Yes	No
MONTH/DAY/YEAR
If yes, will you be graduating this semester?	Yes	No

If no, please indicate the last semester and year you attended Connors State College.______________________

SEMESTER/YEAR

Number of transcripts requested. _______ If requesting copies to be sent directly to you, how many need

to be in individually sealed envelopes? _______

An address must be provided for each transcript requested. Please attach additional paper if necessary for additional addresses.

Name:__________________________________________________________________________________________________

(Name of Recipient/Company/College or University)

If College/University, name of department:____________________________________________________

_________________________________________________________________________________________________________

Street Address	City	State	Zip Code
Student’s Signature (Required)_________________________________________			Date:__________________________

Revised. May 2011