Request for Transcript
Note: One form is required for each transcript of academic record request.
Student Information
Last Name First Name Maiden Name
Apt. #, Street # and Name Town/City
Province/State Country Zip/Postal Code
Tel No. Alternate Tel No.
Email
Student ID # Date of Birth (dd/mm/yy)
Program(s) Attended (Please indicate the transcript and number of official copies required)
Undergraduate Dates Attended No. of Copies
Graduate Dates Attended No. of Copies
Transcript Delivery Regular Mail Courier (Additional fees apply)
Send to student address above Will pick up/ Please call
Release transcript for pick-up to
Send to the following address(s): (Include name of individual/department, company/institution, and address)
1. 2. 3.
Student Signature Date
Notes: • Transcripts will not be issued for any student with an outstanding balance. Students are responsible for ensuring their
account is clear.
• Please allow 5 business days for the processing and mailing of a transcript. Delays may occur during peak seasons.
• Canada Christian College cannot be held responsible for lost or delayed mail.
OFFICE USE ONLY
Payment Method Visa Mastercard Debit Cash Cheque #
Amount Initial Date