COLUMBUS STATE COMMUNITY COLLEGE TRANSCRIPT REQUEST FORM
COMPLETION OF ALL FIELDS IS REQUIRED FOR PROCESSING
PAYMENT MUST ACCOMPANY COMPLETED FORM
PLEASE ALLOW SEVEN (7) BUSINESS DAYS FOR PROCESSING
TRANSCRIPTS WILL NOT BE RELEASED IF YOU HAVE A RESTRICTION ON YOUR RECORD. EXAMPLE: PAST FEES DUE, PARKING FINES, LIBRARY MATERIALS OUT, ETC.
BRING OR MAIL FORM TO:
Columbus State Community College Cashiers Office - Rhodes Hall PO Box 1609 Columbus OH 43216
Cashiers Office Hours of Operation: (For in-person standard or same-day requests):
Monday - Thursday: 8:00 a.m. to 6:00 p.m.
Friday: 9:30 a.m. to 4:30 p.m.
Form may be faxed, with Credit/Debit Card information to: (614) 287-5446
RRP:prc/Revised Transcript Request Form/08-26-2011
Make checks or money orders payable to: Columbus State Community College
REQUEST WILL NOT BE HELD FOR GRADE POSTINGS (E.G.: QUARTERLY GRADE POSTINGS, GRADE CHANGES)
PLEASE CHECK YOUR COUGARWEB ACCOUNT FOR CURRENT GRADE POSTINGS BEFORE ORDERING A TRANSCRIPT
PLEASE USE A SEPARATE TRANSCRIPT REQUEST FORM FOR EACH ADDRESS A TRANSCRIPT IS TO BE SENT
PLEASE PRINT
First Name: ____________________________________________
MI:___________
Last Name:______________________________________________
Previous name used while attending Columbus State Community College:_____________________________________________________________________
Date of Birth: _____/_____/_____ (MM/DD/YYYY)
Students Preferred E-mail Address (REQUIRED): _________________________________________
CougarID Number: _______________________________
OR
Social Security Number: _______________________________
Current Address: _______________________________________________________________________________________
City:_____________________________________________________________________
Daytime Telephone Number: (_______)_____________________________
State:___________
Apt. Number:_____________
ZIP Code:________________________
Evening Telephone Number: (_______)______________________________
Please update my address to the current address listed above.
Standard Processing
Same Day In-Person Pick-Up In-person pick-up requests may not be presented via fax
(Please allow 7 business days from the receipt of the request by
the Department of Records and Registration.)
mail, e-mail, telephone, text, or scanned and e-mailed for payment and processing.
A photo ID is required for the student or individual picking up the transcript. Transcripts will not
be released to an individual other than the student without detailed written permission signed by
the student specifying the name of the person picking up the transcript. The letter, written by the
student, must contain the following: Name of student, Students Social Security Number, Address of
student, Statement of permission to release official transcript, Name of person picking up
transcript, Students signature on the letter and the Transcript Request Form.
Number of copies:_________ @ $2.00 per copy
Number of copies:_________ @ $15.00 per copy
Total number of copies ordered: _________ for a total payment of: $______________
Is this transcript for a graduate program (e.g. Master or Doctoral degree program, Law School or Medical School)?
Is this transcript for employment purposes?
Yes
Yes
No
No
PLEASE SEND TO (REQUIRED): Please Print
Recipient/Institution:_______________________________________________________________________________________________________________
Attention:________________________________________________________________________________________________________________________
Street Address:____________________________________________________________________________________________________________________
City:____________________________________________________________________
State: _______________
SIGNATURE OF STUDENT (REQUIRED):____________________________________________________
FOR OFFICE USE ONLY Cashiers Restriction:
Date transcript processed: ______/______/______
Yes
No
Zip Code__________________
DATE:_______/_______/_______
Comments: __________________________________ Cashier: ______________
Transcript Processed by: ___________________________________
ALL INFORMATION REQUIRED:
PAYMENT TYPE:
CASH
CHECK
MASTER CARD
VISA
DISCOVER
Students Preferred E-mail Address: ______________________________________
CREDIT/DEBIT CARD INFORMATION:
Credit Card Number: __________
Amount to pay: $________
(Payment will not be processed without an e-mail address)
__________
__________ __________
Three-digit Security Code (CVC Code): ________ (This is the three-digit number found on the back of the credit/debit card)
Expiration Date: _______________ (MM/YYYY)
Name as it appears on card:_________________________________________________
