Transcripts will not be released if there are unpaid ...
CURRENT LAST NAME STUDENT ID# OR SSN
TODAY'S DATE
FOR OFFICE USE ONLY Processed by: _____________ Date: ____________________
FIRST NAME
CURRICULUM TRANSCRIPT REQUEST
Office of Student Development
630 S. Main Street, Dobson, NC 27017
Phone: 336-386-3595
Fax: 336-386-3690
MIDDLE
MAIDEN
DATE OF BIRTH
FULL NAME WHILE ENROLLED (if different than above)
APPROXIMATE DATES OF ATTENDANCE
CURRENT PHONE NUMBER
DEGREE RECEIVED FROM SURRY?
DATE DEGREE WAS RECEIVED
TYPE OF DEGREE RECEIVED
YES
NO
Transcripts will not be released if there are unpaid obligations to the college.
TYPES OF TRANSCRIPTS
NUMBER OF TRANSCRIPTS REQUESTED?
Official - Most often required by other educational institutions. This is a signed and sealed copy. ($3.00 per copy)
________ Number of Official
Unofficial - Copy issued to student or faxed. Not signed or sealed (Free)
________ Number of Unofficial
Please allow 5 business days for processing. This does not include time required for mailing, so please plan accordingly.
WHEN WOULD YOU LIKE THE TRANSCRIPT(S) PROCESSED?
Send Now
Hold until semester grades are posted for
Fall Spring Summer
Hold until degree is posted at the end of this semester
HOW WOULD YOU LIKE THE TRANSCRIPT(S) SENT? (Check all that apply)
Please allow the following person to pick-up the requested transcript(s) from the Student Development Office:
Please mail my transcript(s) to the following address(es):
(This person must show photo ID)
Address 1: _________________________________________________
__________________________________________________ Signature and date of person receiving the transcript:
_________________________________________________ _________________________________________________
__________________________________________________
_________________________________________________
Please fax my unofficial transcript to the following:
Address 2: _________________________________________________
Name: ____________________________________________
_________________________________________________
Company: ____________________________________________
_________________________________________________
Fax #: ____________________________________________
_________________________________________________
In accordance with the Family Educational Rights and Privacy Act of 1974, I hereby grant permission to release a copy of my transcript as indicated above.
Signature
Date
Official Transcripts are $3.00 per copy. Transcripts will not be printed until payment has been made through our Business Office.
Payment can be made by cash, check, money order, credit card, or debit card. Please submit payment promptly.
For your convenience, we accept Visa and MasterCard payments. Make checks payable to Surry Community College.
Checks must bear the name, address, telephone number, and driver's license number of the check passer.
Credit card payments can be made by calling 336-386-3208 (or 336-386-3201 after 4:00pm) or by submitting credit card information below.
Card Type
MasterCard Credit
MasterCard Debit
Visa Credit
Visa Debit
Print name on credit card _________________________________________________ 3-Digit Security Code ______________________
Credit card number
_________________________________________________ Expiration Date __________________________
Signature of cardholder _________________________________________________ Total Amount ____________________________
Revised 2/07/2012 Please discard all previous versions
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