Enfield Adult Education Brochures GED Transcript Request Form

Office of Student Supports and Organizational Effectiveness Bureau of Health/Nutrition, Family Services and Adult Education REQUEST FOR OFFICIAL GED TRANSCRIPT THIS FORM CAN BE DUPLICATED PLEASE PRINT Name: _____________________________________________________________________________ First Middle Last (If different from above): Name at the time you took the GED examination _____________________________________________________________________________ First Middle Last YEAR THAT GED TEST WAS TAKEN: ____________ (If not certain, give an approximate year.) LOCATION TEST WAS TAKEN: ______________________________________________________ Last 4-digits of Social Security Number: ___ ___ ___ ___ Date of Birth: ____________________________________________ Current Address: ______________________________________________________________ Street Apartment or Unit Number ______________________________________________________________ Town State Zip Code ___________________________________________________________ Phone Number: CHECK ONE BOX ONLY    MAIL FAX EMAIL Address: (Official Transcript) (Unofficial Transcript) (Unofficial Transcript) _____________________________________________________________ Name of Institution/Employer _____________________________________________________________ Street Suite Number ______________________________________________________________ Town State Zip Code Fax Number: _____________________________________________________________ Email Address: _____________________________________________________________ Signature: __________________________________________ Mailing Address: Phone Number: FAX Number: Date: __________________ GED OFFICE Connecticut State Department of Education 450 Columbus Boulevard, Suite 508 Hartford, CT 06103 (860) 807-2111 or 2110 (860) 326-0519 The Connecticut Department of Education (SDE)collects, processes, and protects confidential or restricted data pursuant to the requirements of Personal Data Act Conn. Gen. Stat. §4-190 et seq., and the State Policy on Security for Mobile Computing and Storage Devices, and the SDE’s Data Protection Policy and Procedures.