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OFFICIAL TRANSCRIPT RELEASE (Please print or type) Date:___________________ Name:________________________________________________________________ List maiden name (or name at time of attendance):_____________________________ Current Address:________________________________________________________ ________________________________________________________ Current Phone Number: ___________________________________________________ Date of Birth: _____________ Social Security Number:__________________________ Dates of Attendance and/or Graduation: ______________________________________ Class(es) taken: _________________________________________________________ Check below all that apply: __ I hereby request my transcript be mailed to: ______________________________________________________________ __ I hereby request my transcript be given to: ______________________________________________________________ I hereby authorize officials of the Great Plains Technology Center to release information regarding my attendance and grades for classes I have attended to the above named party. _____________________________ ____________________________________ Student’s Signature Parent/Guardian (if not of legal age) ________________________________________________________________________ FOR OFFICE USE ONLY: Student to present picture ID upon receiving transcript. Employee Initials: Sent By: Date Sent: |