FORMER HIGH SCHOOL OR COLLEGE TRANSCRIPT REQUEST …

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Revised June 2013 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 NON-DISCRIMINATION STATEMENT St.

Revised June 2013 FORMER HIGH SCHOOL OR COLLEGE TRANSCRIPT REQUEST FORM Please send my official academic transcript, including any placement test scores to:

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