REQUEST FOR ACEDEMIC 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 mailed to:
Student Records, Centennial College. P.O. Box 631. Station A, Toronto,
Ontario, Canada M1K 5E9 or emailed to studentrecord@centennialcollege.ca

Date stamp

For records use only

Please note:

BScN students must request transcripts through Toronto Metropolitan University.
Transcripts will not be released to students who have outstanding liabilities with the College.
It is the student's responsibility to review your academic record for accuracy.
Incomplete or incorrect requests may result in a processing delay.

ABOUT YOURSELF

Student number:

Legal Surname(Last Name): Legal First Name:

Street Address:

City: Province: Postal Code:

Telephone: Bussiness Telephone:

E-mail: Date of Birth:

Name of program in which you were registered: Program #:

TOTAL NUMBER OF TRANSCRIPTS REQUESTED: x $12.00 = $:

Note: Transcipts will NOT be produced until payment is received. Transcript production normally requires 7 to 10 business days.

I WISH MY TRANSCRIPT(S):

Mailed now

Held to reflect graduation

Sealed individually

Held for fall grades

Held for winter grades

Held for summer grades

AUTHORIZATION TO MAIL TRANSCRIPT - All transcripts are sent by regular Canada Post service. Please note no tracking capabilities are available.

Use this section only if you wish to have your transcripts MAILED to instituitions or to you. I authorize Enrolment Services, Centennial College, to mail a transcript of my permanent academic record to the following individuals or instituitions (List a maximum of 2 addreses and include your mailing address. If copies are to be mailed to you).

1) Name:

2) Name:

Mailing Address:

CREDIT CARD PAYMENT

Card Holder Name: Card Number:

Type of Card: Visa Master Card American Express Expiry Date: Security Code:

Please note debit cards cannot be accepted.

PLEASE SIGN HERE

By signing this application, I authorize the applicable changes to the above card and acknowledge that the information provides is accurate and complete.

SIGNATURE OF APPLICANT*

DATE