Transcript Request Form
  • The Family Educational Rights and Privacy Act (FERPA) requires that transcript requests be made in writing and signed by the student.
  • Complete and sign this form and mail to the address below with check or money order.
  • Costs per each transcript requested are:
    Unofficial transcript: $1.40
    Official transcript: $4.03
  • Allow 72 hours for processing.
PLEASE PRINT OR TYPE
 Date of Request:


_____/_____/________

 Student ID Number:


___________________

  Birth date:


_____/_____/________

 All Former Name(s):


___________________
 Last Name:

___________________

  First Name:

___________________

  Middle Name:

___________________

  
 

Your mailing address:
________________________________________________________
________________________________________________________
________________________________________________________

Complete address to which transcript is to be mailed:
(If more than one, enter the additional addresses on the backof this form.)
________________________________________________________
________________________________________________________
________________________________________________________
Process this request:
(Check One Only)		 ____ Immediately.
____ At the conclusion of the current quarter.
____ After posting of Degree/Certificate.
____ After grade corrections noted.
Course: _______ Course No: _______ Quarter/Year: _______
 
The last I attended Centralia College was:
(Check One Only)		 ____ Fall
____ Winter
____ Spring
____ Summer		 19____

20____
       
 
Number of copies:
(Enter the number of copies.)		 ____ OFFICIAL: Mailed directly to second party. Carries the Registrar's signature.
____ OFFICIAL IN SEALED ENVELOPE: Carries Registrar's signature, and is stamped "Issued to Student." In order to be valid, must be transmitted to second party in a sealed envelope.
____ UNOFFICIAL - STUDENT COPY
 
 
 I HEREBY AUTHORIZE THE RELEASE OF MY TRANSCRIPT

Signature ________________________________
       
Mail or Fax to: Centralia College
Attn: Transcripts, Admissions & Records
600 Centralia College Blvd
Centralia WA 98531
Phone: (360) 736-9391, ext. 221; from Olympia: 753-3433, ext. 221
Fax: (360) 330-7503