Transcript Request Form - District Of Columbia Education Licensure Commission
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1DISTRICT OF COLUMBIA
EDUCATION LICENSURE COMMISSION
Transcript Request Form
PLEASE TYPE OR PRINT LEGIBLY USING BLUE OR BLACK INK.
Transcripts are $10 per copy. A non-refundable check or money order should be made payable to the DC
Treasurer.
st
nd
Return completed form and payment to Education Licensure Commission, 810 1
St, NE, 2
Floor Washington,
DC 20002.
Please use separate transcript request forms if you wish to send transcripts to more than one location.
Transcripts are certified copies of the records as they appeared in the Office of the Registrar upon the school’s
closing.
Official copies, which bear the seal of the Commission, must be mailed directly to the institutions.
Transcripts that are issued directly to students are considered unofficial copies.
Please allow thirty (30) days for the processing of transcript requests.
STUDENT INFORMATION
Name: _________________________________________________________ Birthdate: _______________
Last
First
Middle
SSN: ____________________________ Name While Enrolled:__
______
Current Address:_________________________________________________________________________
Street
Suite/Apt #
City/State
Zip
Phone #: (_______)________________________ E-mail _____________________________________________
INSTITUTION INFORMATION
Institution Name:
Date(s) of Attendance:
to
_Degree/Program Name:_____________________________
MAIL TRANSCRIPT TO
Name
# of copies: _________________
_________________________________________________________________________________
Need separately sealed
transcripts
Address
______
________________________
City/State/Zip Code
Mail all transcripts together
_____
____________________________________
Pick-Up (Photo ID required)
STUDENT AUTHORIZATION
You must sign and date this form in order for this request to be processed.
Signature ____________________________________________________Date_______________________
FOR OFFICE USE ONLY
Date received: ____________
Received By: ______________
Amount of Payment:______________ Date Transcript mailed: _____________
Rev 6/14
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