Fax
Number: 731-254-9558
RELEASE OF INFORMATION AUTHORIZATION/REQUEST FOR TRANSCRIPT
Transcripts bearing the School
Seal are not issued to students.
Unofficial transcripts may be obtained for personal use. No charge is made for transcripts. Once you have completed all of the
information below you may either mail or fax the request to us.
Please send a complete transcript of my record to:
______________________________________________________________
(Name &
Office of College or Business)
______________________________________________________________
(Complete Street Address)
______________________________________________________________
(City, State, & Zip Code)
Year Attended:________________________
Class Attended:_____________________________
Class Was: Day (
) Night ( )
Class Instructor:____________________________
Your Name as Attended:__________________________________________________
Social Security Number:_________________________________
Current Mailing Address:__________________________________________________
__________________________________________________
Current Phone Number: _________________________________
_____________________________________ __________________
(Signature) (Date)
FOR OFFICE USE ONLY:
Please Check One: ( )
Student Copy
(
) Official Copy
Date Mailed:___________________