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happydrumz396
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13 views1 page

Transcript Request

Uploaded by

happydrumz396
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORMER HIGH SCHOOL OR COLLEGE

TRANSCRIPT REQUEST FORM


Please send my official academic transcript, including any placement test scores to:

ST. JOHNS RIVER STATE COLLEGE


ATTN: ADMISSIONS OFFICE
5001 ST. JOHNS AVENUE
PALATKA, FLORIDA 32177

COLLEGES AND UNIVERSITIES: PLEASE PROVIDE


COURSE DESCRIPTIONS FOR ALL COURSES ON
STUDENT’S ACADEMIC TRANSCRIPT.

If there is any charge for this transcript, or if my transcript cannot be forwarded


immediately, please notify me at the address and phone number listed below:

STUDENT’S NAME: _______________________________________________________

SOCIAL SECURITY NUMBER:_____________________________________________

DATE OF BIRTH:_______________________

STREET ADDRESS:______________________________________________________

CITY, STATE ZIP CODE:__________________________________________________

DAYTIME TELEPHONE NUMBER:______________________________

DATES OF ATTENDANCE:_____________________________________

______________________________________________________________________________
STUDENT’S SIGNATURE DATE

St. Johns River State College, an equal access institution, prohibits discrimination in its employment, programs, activities, policies and procedures
based on race, sex, gender, gender identity, age, color, religion, national origin, ethnicity, disability, pregnancy, sexual orientation, marital status,
genetic information or veteran status. Questions pertaining to education equity, equal access or equal opportunity should be addressed to the
College Title IX Coordinator/Equity Officer: Charles Romer, Room A0173, 5001 St. Johns Avenue, Palatka, FL 32177; (386) 312-4074;
[email protected]. Anonymous reporting is available at SJRstate.edu/report. Inquiries/complaints can be filed with the Title IX
Coordinator/Equity Officer online, in person, via mail, via email or with the US Department of Education, Office of Civil Rights, Atlanta Office,
61 Forsyth St. SW Suite 19T10, Atlanta, GA 30303-8927.

Revised June 2013

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