$3.00 each $5.00 each Official Copy

REQUEST FOR GED TEST RESULTS? ¨C

Please allow 14 business days for processing.

Name: ____________________________________________________________________________________

Last Name

First Name

Middle Initial

(List previous last names used)

Social Security Number: ____________________________

Birth date: ______________________

Present Address: ________________________________________

Test Date: ______________________

Street/ P.O. Box

________________________________________

City

State

Signature: _________________________________________

Date: _________________________

No. of copies: ____ Unofficial Copy:

$3.00 each

____ Official Copy (Columbia College Seal): $5.00 each

Mail Copy(ies) to:

(If different from

above address)

Phone No.: _____________________

Zip

[Make Checks payable to

Columbia College]

Credit Card #_________________________________

__________________________________ Exp. Date _____________ Visa__ M/C__ Discvr_____

__________________________________ 3-digit CVC code on back of credit card _________

__________________________________

?

Mail or deliver this request to: GED /Student Services Office

Columbia College

11600 Columbia College Drive

Sonora, CA 95370

Cardholder Signature___________________________

Cardholder billing name and address:

mm/GED Transcripts?/Revised 1/4/13

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