YORK TECHNICAL COLLEGE

Transcript Request Form

Please send an official transcript to:               Please indicate who completed this request from the responding college/university and may be contacted

Human Resources Department                     if there is a question.

York Technical College

452 S. Anderson Road                                    Name: _______________________________________

Rock Hill, S.C. 29730

Phone: 1-(803)-327-8000                               Phone: _______________________________________

NAME: _________________________________________________________________ _____________

              Last                                      First                     Middle                        (Maiden)

ANOTHER NAME UNDER WHICH YOUR RECORDS MAY APPEAR

_____________________________________________________________________________________

             Last                                      First                      Middle                       (Maiden)

Social Security Number _______-____-_______           Date of Birth _______/___/_______

Name of School: ______________________________________________________________________

Address of School: ____________________________________________________________________

____________________________________________________________________________________

Last Date of Attendance: ______/_____/_______

Degree(s) Earned                                                        Date(s) Earned

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Name of Requestor:  _________________________________________________

Position(s) applied for: _______________________________________________

Address: __________________________________________________________

__________________________________________________________________

Telephone: ______________________________________________________

My signature below authorizes release of transcript(s).

____________________________________________________     ________/_____/________

                            Signature                                                                           Date

Please forward this form to each Institution of Higher education attended.

Note: All costs associated with this request should be forwarded to the requestor.