Instructions:   After printing this form, please fill it out, sign and mail/fax to the Admissions  and Records Office.  See Directory for addresses and fax numbers. Print your information clearly.  Students are responsible for complete and legible information.

   Last Name                                  First                                 Middle

  Current Mailing Address

         City                                       State                            Zip

        Date of Birth                                      Social Security Number

        Home Phone                                       Work Phone

I AUTHORIZE COLLIN TO RELEASE MY TRANSCRIPT.

MAIL TRANSCRIPT TO:

Name of High School, College, or University

Address  (Note: Complete mailing address is required.)

        City                             State               Zip

Number of Copies:

Signature: 

Date: