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TRANSCRIPT REQUEST

Student Name: ________________________________________ Date: ___________________________

Birth Date: _____________________________	Phone: ____________________________

Program/Trade Area: _____________________________________________________

Date Entered:

Date Withdrawn:

Date Completed:

____________________

____________________

____________________

Records requested:	_____ Transcript	_____Certificate

Send Official Transcript to:

Name: ______________________________________________________________________________

Address: ____________________________________________________________________________

City: ________________________________ State: ______________________ Zip: _____________

Phone: ______________________________________

___________________________________ Signature of Student

_______________________ Date

All Financial obligations to Auburn Career Center must be reconciled prior to the release of an academic transcript.

8140 Auburn Road * Concord Twp. OH 44077 * 440.357.7542 * 440.358.8012 (Fax)

DLC – 2/14/2019