Free 48905.PDF - Indiana

REQUEST AND AUTHORIZATION FOR RELEASE OF STUDENT RECORDS
State Form 48905 (5-98)

I, _______________________________________________ hereby, request and authorize the Indiana Commission on Proprietary Education to release a copy of my official student transcript to each person or place named below. List full name, address, and / or fax number of the party who is to receive the transcript including your name and address if you wish to receive a copy, also.

To locate your student record the following information is required: Student name at time of attendance: Social Security number: School attended: Location of school: Dates attended: Course or program name: Your current address: Telephone number: (work) (home) Birthdate:

Signature required for release: Signature of requestor Date

Mail or Fax your Transcript Request to:

INDIANA COMMISSION ON PROPRIETARY EDUCATION 302 WEST WASHINGTON STREET, ROOM E201 INDIANAPOLIS, IN 46204 TELEPHONE NUMBER: (317) 232-1320, or TOLL FREE IN STATE 1-800-227-5695 FAX NUMBER: (317) 233-4219

NOTE: A transcript is considered official only when sent directly from this agency to the designated institution or employer.