REQUEST FOR
ACADEMIC TRANSCRIPT
Completion of the address section of “About Yourself” will result in
an automatic updating of your permanent address on the College file.
Transcripts will be produced with your name as it is depicted on the
College’s file. This form can be faxed to: 416 289-5232 or to: Student
Records, Centennial College, P.O. Box 631, Station A, Toronto, Ontario, Date Stamp For Records use only
Canada M1K 5E9
Please note:
1. BScN students must request transcripts through Ryerson University.
2. Transcripts will not be released to students who have outstanding liabilities with the College.
3. It is the student’s responsibility to review your academic record for accuracy.
4. Incomplete or incorrect requests may result in a processing delay.
ABOUT YOURSELF
Student Number: ____|____|____| - ____|____|____| - ____|____|____|
Legal Surname (Last Name):_______________________________________ Legal First Name:__________________________________________
Former Surname (If Applicable):_____________________________________ Middle Name: ____________________________________________
Street Address:___________________________________________________________________________________________________________
City: _____________________________________________ Province:___________________________ Postal Code: __________________
Telephone: (_____)_________________________Business Telephone: (_____)
E-mail: _______________________________________________________ Date of Birth: _____________________________________________
Year Month Day
Name of program in which you were registered: _____________________________________________________ Program #: __________________
TOTAL NUMBER OF TRANSCRIPTS REQUESTED: ______ X $12.00 = $___________
NOTE: Transcripts will NOT be produced until payment is received.
Transcript production normally requires 7 to 10 business days.
I WISH MY TRANSCRIPT(S): Held for fall grades Held for pick-up at Progress Sealed individually
Held for winter grades Mailed Held to reflect graduation Held for summer grades
REQUEST FOR IN-PERSON COLLECTION OF TRANSCRIPTS
I authorize Enrolment Services to hold my transcript(s). I will personally collect my transcripts from Enrolment Services at the Progress Campus. If I opt to
have someone other than myself collect the transcripts, I will provide that person with a signed letter of authorization.
AUTHORIZATION TO MAIL TRANSCRIPT – All transcripts are sent by regular Canada Post service.
Use this section only if you wish to have your transcripts MAILED to other institutions or to you.
I authorize Enrolment Services, Centennial College, to mail a transcript of my permanent academic record to the following individuals or institutions (List a
maximum of 2 addresses, and include your mailing address if copies are to be mailed to you).
1) Name:_____________________________________________________ 2)_ Name:________________________________________________
Mailing Address:_____________________________________________ Mailing Address:_________________________________________
__________________________________________________________ _____________________________________________________
__________________________________________________________ _____________________________________________________
CREDIT CARD PAYMENT
Card Holder Name__________________________________________________Card Number:_____________________________________________
Type of Card: Visa MasterCard American Express Expiry Date:_______________________ Security Code_____________________
PLEASE SIGN HERE
By signing this application, I authorize the applicable charges to the above credit card and acknowledge that the information provided is accurate and
complete.
______________________________________________________________________ _________________________________
SIGNATURE OF APPLICANT DATE
07/2013
