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Transcript Release Form

Transcript Release Form

Fill out all required information. Failure to complete in full will delay processing.

Indicates required field *

First Name*

Last Name*

SSN (Last 4 digits)*

Address*

City*

State*

Zip*

Phone*

Email*

I request that a copy of my transcript for the Clinical Massage Therapy Diploma Program be sent to the following address:

Destination Name*

Destination Address*

Destination City*

Destination State*

Destination Zip*

I understand that if I am a graduate or withdrawn student that a transcript will not be issued if there are any tuition or other fees outstanding on my account.

By checking this box, I authorize this form.





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