Transcript Request Form - Three Rivers Community College
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1Transcript Request Form
There is no fee to process a transcript request
Three Rivers Community College
Phone: (860)215-9064
Attn: Transcripts
Fax:
(860)215-9919
Registrar’s Office – Rm A115
email: registrar@threerivers.edu
574 New London Turnpike
Norwich, CT 06360
or
@ ___ ___ ___ ___ ___ ___ ___ ___
____ ____ ____ ____
_____ /_____ / ______
Student ID#
Last 4 of Social Security#
Date of Birth
_________________________________________________
____________________________________
Student’s Name
Previous Name
____________________________________________
Dates of Attendance:
Current Address
Currently attending
Previously attended _______________
_________________________
______ __________
(approximate date(s) if actual unknown)
City
State
Zip
Graduated: No
Yes
Year _________
(___ ___ ___) ____ ____ ____ - ___ ___ ___ ___
(approximate year if actual unknown)
Telephone#
(print receiver’s name and address below or self on the name line if you are the receiver)
Send to:
Self – Official transcripts must remain in a sealed envelope and are not to be opened by student.
Person or Institution – indicated below
______________________________________________
Official - Number of Copies
________
Name
Unofficial - Number of Copies ________
______________________________________________
(available online for current students)
Address
Send Now
______________________________________________
Address
Send after grades are posted
___________________________
______
_________
City
State
Zip
With my signature, I authorize Three Rivers CC to release copies of my academic record to the person or institution
indicated above with the understanding that the named recipient will not release the record to a third party without my
written consent.
_______________________________________________
_________________________________
Student’s Signature
Date
Allow approximately 2 to 5 working days for processing. Beginning and ending of semester may cause delay.
Note: transcripts are not faxed
08/04/16vw
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