"Request for Official Ged Transcript" - Connecticut

Request for Official Ged Transcript is a legal document that was released by the Connecticut State Department of Education - a government authority operating within Connecticut.

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Download "Request for Official Ged Transcript" - Connecticut

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Division of Family and Student Support Services
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
Name at the time you took the GED examination (if different from above):
_____________________________________________________________________________
First
Middle
Last
YEAR THAT GED TEST WAS TAKEN: ____________ (If not certain, give an approximate year.)
Last 4-digits of Social Security Number: ___ ___ ___ ___
Date of Birth:
____________________________________________
______________________________________________________________
Current Address:
Street
Apartment or Unit Number
______________________________________________________________
Town
State
Zip Code
___________________________________________________________
Phone Number:
MAIL OR FAX AN ADDITIONAL TRANSCRIPT TO:
_____________________________________________________________
Address:
Name of Institution/Employer
_____________________________________________________________
Street
Suite Number
______________________________________________________________
Town
State
Zip Code
_____________________________________________________________
Fax Number:
Signature: __________________________________________
Date: __________________
Mailing Address:
GED OFFICE
Connecticut State Department of Education
25 Industrial Park Road
Middletown, CT 06457
Phone Number
(860) 807-2110 or 2111
FAX Number
(860) 807-2112
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.
Division of Family and Student Support Services
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
Name at the time you took the GED examination (if different from above):
_____________________________________________________________________________
First
Middle
Last
YEAR THAT GED TEST WAS TAKEN: ____________ (If not certain, give an approximate year.)
Last 4-digits of Social Security Number: ___ ___ ___ ___
Date of Birth:
____________________________________________
______________________________________________________________
Current Address:
Street
Apartment or Unit Number
______________________________________________________________
Town
State
Zip Code
___________________________________________________________
Phone Number:
MAIL OR FAX AN ADDITIONAL TRANSCRIPT TO:
_____________________________________________________________
Address:
Name of Institution/Employer
_____________________________________________________________
Street
Suite Number
______________________________________________________________
Town
State
Zip Code
_____________________________________________________________
Fax Number:
Signature: __________________________________________
Date: __________________
Mailing Address:
GED OFFICE
Connecticut State Department of Education
25 Industrial Park Road
Middletown, CT 06457
Phone Number
(860) 807-2110 or 2111
FAX Number
(860) 807-2112
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.