Transcript Request Form

Note: Requests from employers or educational institutions should be emailed to transcripts@collins-cc.edu.

Student Legal Name:*

First NameMiddle NameLast Name

Would your Transcript be Under a Maiden Name or Name?

YesNoUnsure

Former Name:

Date of Birth:*

What Year Were You Enrolled at or Graduate from CCTC?*

Which Program Did You Take at CCTC?

Example: Radiologic Technology

Last 4 of SSN:*

Phone Number:*

Please enter a valid phone number.

Email Address:*

example@example.com

Your Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Transcript Processing Service

Regular – mailed within three business daysDelayed Service – hold for current semester gradesDelayed Service – hold for completion of program

How do you want to get your transcripts?*

I want my transcripts to be mailed.I want my transcripts sent via email.I want my transcripts to be faxed to an educational institution.I want to pick my transcripts from the CCTC Main Campus.I want to pick my transcripts from the CCTC Coal Grove Campus.I want to pick my transcripts from the CCTC Proctorville Campus.

Name of Organization You Would Like to Receive Your Transcripts:*

Send My Transcripts to:

example@example.com

Name of the Person or Department Who Should Receive the Fax:*

Fax To:

Please enter a valid phone number.

Ship To:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I, the undersigned, hereby request that Collins Career Technical Center ("the School") provide a copy of my academic transcripts to the designated recipient(s). I understand and agree to the following terms and conditions:

Authorization: I authorize the School to release my academic transcripts, which may include personal identification information, grades, course information, and other educational records, to the recipient(s) I have designated in my Request.
Accuracy of Information: It is crucial to ensure the accuracy, completeness, and truthfulness of all information provided in this transcript request, including your identity and the intended recipient(s) of the transcripts. Any false or misleading information may result in denying your Request or other legal consequences.
Privacy and Confidentiality: We understand that your academic transcripts contain confidential information. Rest assured, the School will handle your Request in strict compliance with the Family Educational Rights and Privacy Act (FERPA) or other applicable privacy laws, ensuring that your academic information is protected and released only with your authorization.
No Guarantee of Delivery or Receipt: While the School will make every reasonable effort to process and deliver my academic transcripts promptly, I acknowledge that the School cannot guarantee delivery by a specific date or time and is not responsible for transcripts that are lost, delayed, or misdirected once they have been sent to the designated recipient(s).
Limitation of Liability: I agree that the School shall not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages, including but not limited to damages for loss of profits, goodwill, use, data, or other intangible losses, resulting from the handling, processing, or transmission of my transcript request.
Changes to Request: Please note that changes to the recipient(s) or other details may not be possible once your Request has been submitted. It is your responsibility to review and confirm all information before submission.
Governing Law: This agreement shall be governed by and construed in accordance with the laws of the state where the School is located without giving effect to any principles of conflicts of law.

By checking the box below, I affirm that I have read, understand, and agree to the abovementioned terms and conditions. I further acknowledge that this authorization constitutes my electronic signature and has the same legal effect as a written signature.

I Agree to these Terms and Conditions

I Agree to these Terms and Condidtions*

Yes

Student Signature:*

Date:*

Transcript Request Form

Personal Information

Transcripts Should Be Sent To:

Terms and Conditions