REQUEST FOR TRANSCRIPT

(Please Print Clearly)

DATE: _______________________________________

TO: OFFICE OF THE REGISTRAR

INSTITUTION: ____________________________________________________

ADDRESS: _______________________________________________________

CITY, STATE, ZIP: _________________________________________________

Please forward an official copy of my transcript to:

FINANCIAL AID OFFICE
BARSTOW COLLEGE
2700 Barstow Road
Barstow, CA 92311

I attended your institution from ___________________ to _______________________.

I graduated on __________________________________________________________.

Month/Year

__________________________________________________ DEGREE

__________________________________________________ MAJOR

Your records reflect my name at the time of attendance as:

Last: _________________________ First: ______________________ MI: ___________

SSN: _________________________ or, Student #: ______________________________

Date of Birth: _____/______/______ Place of Birth: _____________________________

FEE ENCLOSED: $ ____________ (If there is no fee due for my transcript, please return check, money order, etc., to my home address listed below.) Thank you.


Name: _________________________ Phone Number: ___________________________

Address: ________________________________________________________________
                                                        Mailing Address, City, State, Zip

Signature: _______________________________________________________________