"Transcript Request Form - Nursing & Allied Health Division - Chattanooga State Community College" - Tennessee

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Transcript Request Form ‐ Nursing & Allied Health Division
Only use the N&AH Transcript Request Form to request transcripts from your previous high school and/or college(s).  
Important Notes to Student:
The Nursing & Allied Health transcript request form should be mailed or hand carried to your high school and all 
previously attended colleges. The transcript will be mailed to your current address or can be given directly to you.  The 
student will keep the official transcript and submit only a copy with your program application(s). 
 
 
High School Transcripts:
A copy of your high school transcript is required for: EMS Programs and PTA applicants who do not have college level 
courses completed.  If you are using high school credit for “Chemistry”: a copy of high school transcript is required for 
RN, and DH.  
 
Previous College Transcripts:
If your transfer credits are showing on the Chattanooga State transcript, no transcripts are needed. The Nursing & Allied 
Health Division also accepts self‐printed transcripts from your previous college.  
 
 
ChSCC Admissions Office Transcripts:  
All previously attended transcripts sent to Chattanooga State Admissions Office cannot be copied and forwarded to the 
Nursing & Allied Health Division.   
Registrars: High School and College
The N&AH Division would like to request that the Transcript of Academic Record be sent to the student’s current 
address below or handed to the student. Note to Registrar: If there is any charge for this service, please bill the student 
at the address below. If you have questions contact the Nursing & Allied Health Division Office at 423‐697‐4450.  
 
Student:
Fill out clearly & completely before mailing or hand carrying form to your school. No transcripts needed if
attending Chattanooga State.
I last attended your school in ______________________________. For identification purposes, the name under which  
I attended your school was ______________________________________________________________. My birth date  
is _______________________________ and my Social Security Number is ___________________________________. 
 
Students current address for Registrar to send transcripts:
 
Student’s Name: ___________________________________________________________________________________ 
Current Address: ___________________________________________________________________________________ 
City/State/Zip: _____________________________________________________________________________________ 
Student Phone Number(s): ___________________________________________________________________________
           
Student Email Address(s) _____________________________________________________________________________ 
 
Respectfully, 
_________________________________________     _________________________________________   ____________ 
                        Student’s Printed Name   
 
                      Student’s Signature                                       Date  
Chattanooga State Community College does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, 
religion, creed, national origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other 
legally protected class with respect to all employment, programs and activities sponsored by Chattanooga State. The following person has been designated to handle 
 
inquiries regarding the non‐discrimination policies: Director, Human Resources, 4501 Amnicola Highway, Chattanooga, TN 37406, 423‐697‐2417.
Transcript Request Form ‐ Nursing & Allied Health Division
Only use the N&AH Transcript Request Form to request transcripts from your previous high school and/or college(s).  
Important Notes to Student:
The Nursing & Allied Health transcript request form should be mailed or hand carried to your high school and all 
previously attended colleges. The transcript will be mailed to your current address or can be given directly to you.  The 
student will keep the official transcript and submit only a copy with your program application(s). 
 
 
High School Transcripts:
A copy of your high school transcript is required for: EMS Programs and PTA applicants who do not have college level 
courses completed.  If you are using high school credit for “Chemistry”: a copy of high school transcript is required for 
RN, and DH.  
 
Previous College Transcripts:
If your transfer credits are showing on the Chattanooga State transcript, no transcripts are needed. The Nursing & Allied 
Health Division also accepts self‐printed transcripts from your previous college.  
 
 
ChSCC Admissions Office Transcripts:  
All previously attended transcripts sent to Chattanooga State Admissions Office cannot be copied and forwarded to the 
Nursing & Allied Health Division.   
Registrars: High School and College
The N&AH Division would like to request that the Transcript of Academic Record be sent to the student’s current 
address below or handed to the student. Note to Registrar: If there is any charge for this service, please bill the student 
at the address below. If you have questions contact the Nursing & Allied Health Division Office at 423‐697‐4450.  
 
Student:
Fill out clearly & completely before mailing or hand carrying form to your school. No transcripts needed if
attending Chattanooga State.
I last attended your school in ______________________________. For identification purposes, the name under which  
I attended your school was ______________________________________________________________. My birth date  
is _______________________________ and my Social Security Number is ___________________________________. 
 
Students current address for Registrar to send transcripts:
 
Student’s Name: ___________________________________________________________________________________ 
Current Address: ___________________________________________________________________________________ 
City/State/Zip: _____________________________________________________________________________________ 
Student Phone Number(s): ___________________________________________________________________________
           
Student Email Address(s) _____________________________________________________________________________ 
 
Respectfully, 
_________________________________________     _________________________________________   ____________ 
                        Student’s Printed Name   
 
                      Student’s Signature                                       Date  
Chattanooga State Community College does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, 
religion, creed, national origin, sex, sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other 
legally protected class with respect to all employment, programs and activities sponsored by Chattanooga State. The following person has been designated to handle 
 
inquiries regarding the non‐discrimination policies: Director, Human Resources, 4501 Amnicola Highway, Chattanooga, TN 37406, 423‐697‐2417.