GED, High School Diploma Request for Transcripts

GED, High School Diploma Request for Transcripts

Student Name * First Last
Last Name at time of Graduation *
Social Security # *
Date of Birth * / MM / DD YYYY
Name of High School/GED Facility *
Date Attended *
High School Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
School Phone Number * - (###) - ### ####
Current Address of Student *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Student Signature *
Please select your Admissions Representative:
Admissions Representative *
Please send/fax a copy of the transcript for above student:

Institute of Integrative Healing
2101 E. 4th Street, Suite 102
Santa Ana, CA 92705
or fax a copy to 714-953-4324
Attn: Registrar
Did you attend High School for 4 years? * Yes No
Did you complete your high school diploma or GED online? *
If no, please explain