TENNESSEE TECHNOLOGY CENTER AT WHITEVILLE

PO BOX 489, WHITEVILLE, TN  38075

FAX (731) 254-9558

REQUEST FORM FOR GED SCORES TO BE TRANSFERRED

Please fill out all information – Scores cannot be transferred if all information is not completed.  Please allow 5 days for processing.

Name __________________________________________________________________

            Last                              First                             Middle                         Maiden

Address:________________________________________________________________

              Street or P.O. Box                            

_______________________________________________________________________

City                                                      State                                                    Zip

Phone No. _______________________         Date of Birth ________________________

Name at time of Test ______________________________________________________

Social Security No.________________________________________________________

Year You Took Test ______________________________________________________

Name and Address where you want your test scores transferred to:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Signature ____________________________ Date _________________________

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Office Use Only

Date of Request _________________

Date Transcript Processed ______________   Processed By_______________________