Cleveland State Community College
Official Transcript Request
Please Note:
• Transcripts of records are issued only at the request of the student and can be faxed only Cleveland State Community College
to other educational institutions. P.O. Box 3570 • 3535 Adkisson Dr.
• No academic transcripts will be released until the student’s admissions file is complete and Cleveland, TN 37320-3570
all financial obligations to the college are met. Phone: (423) 478-6214
• Transcripts of records will not be released to a third party without written consent of the student.
• Student copies are available on CougarNet Fax: (423) 478-6255
Name___________________________________________________ Soc. Sec. # - -
Last First Middle
_______________________________________________________ Date of Birth - -
Address
Month Day Year
_______________________________________________________ Phone #________________________________________
City State Zip
______________________________________________
_______________________________________________________ Maiden or Previous Name
Student Signature ❑ Currently Enrolled
❑ Previously Enrolled
To be sent: ❑ Now ❑ End of Term ❑ After Degree is Posted ❑ Enrolled before 1986
❑ To be picked up ___________________(date)
Number of copies requested___________
Please send to:_________________________________________________ Date requested_____________________
______________________________________________________________
OFFICE USE ONLY
______________________________________________________________ Received By Date Sent Sent By
______________________________________________________________
CSCC AR/9049/2/19/09