Wallace Community College - Enrollment Services Transcript Release Authorization

Transcript Release Authorization Form

Name:

Last:

First:

Middle:

Address:

Phone Number:

()

(area code) xxx-xxxx

Social Security Number:

Date of Birth (mm-dd-yyyy):

- -

School or College Attended:

Name Used While Attending:

Date of Attendance (mm-dd-yyyy):

From:	To:

Date of Graduation or GED Earned:

Graduation: GED:

I Plan to Attend (records will be sent to):

	Wallace Campus or Fort Rucker Center
	Sparks Campus