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
[phone] or 2110
[phone]
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.