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SR 415 (08/08)

St. Petersburg College
Central Records

P.O. Box 33089 TRANSCRIPT REQUEST
St. Petersburg, FL 33733

REQUEST FOR HIGH SCHOOL OR COLLEGE TRANSCRIPT
STUDENT:
Please send a completed form directly to each high school and college previously attended.
SCHOOL: Please attach this form to the official transcript and mail to the address above.

Permission is hereby granted for the release of my transcript to St. Petersburg College.
Please print or type
Name:_____________________________________________________________________________________________
Last First Middle

Address:___________________________________________________________________________________________
Street City State ZIP code

I attended high school/
college under the name(s):
Years attended

Birth date (optional) Social Security number Year graduated
Name of high school/college:
City/State:

Regulation requires the student’s signature to release a transcript.
I acknowledge by my signature I understand the college is collecting my Social Security number for the purpose of
complying with federal and state statutes related to employment, financial and academic assistance, and inter-institutional
articulation or transfer, and that the college may disseminate that information in some communications with outside
organizations, while taking precaution to safeguard use of the number. I also understand that should I choose not to have
my Social Security number transmitted to the Internal Revenue Service (IRS) in response to Hope/Lifetime Learning Tax
Credit reporting, I face the possibility of a fine of $50.

Student’s signature Date

St. Petersburg College is dedicated to the concept of equal opportunity. The college will not discriminate on the basis of race, color, religion, sex, age, national origin,
marital status, or against any qualified individual with disabilities, in its employment practices or in the admission and treatment of students. Recognizing that sexual
harassment constitutes discrimination on the basis of sex and violates this rule, the college will not tolerate such conduct. Should you experience such behavior, please
contact the director of EA/EO at 727-341-3261; by mail at PO Box 13489, St. Petersburg, FL 33733-3489; or by e-mail at eaeo_director@spcollege.edu