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Colorado
School of Mines
Teacher
Enhancement Program
Request for Official Transcript
of Record
(Print out this form, fill it in and either
mail or fax it to us with your payment for each transcript requested.)
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Please print all information:
Full Name:______________________________
Social Security Number:__________________
Home Phone: (_____)_____________________
_____ Hold for pick-up
_____ Mail to:
________________________________________
________________________________________
________________________________________
________________________________________
Mailing address:
Teacher Enhancement Office
Colorado School of Mines
PO Box 4028
Golden, CO 80401-0028
Fax Number: 303/273-3314
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List below
all CSM Teacher Enhancement courses taken within the last six months that
you want to appear on your transcript.*
__________________________________________
__________________________________________
__________________________________________
__________________________________________
*The Teacher
Enhancement Office is not responsible for the omission of any recent courses
(within the past six months) if you do not list them above.
Transcripts
cost $6.00 per copy.
Number of
copies requested: _____
Amount enclosed: $__________
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Signature:(required) ___________________________________ Date:
______________
| The Teacher Enhancement
Office and Colorado School of Mines cannot be responsible for meeting
individual deadlines for credits toward teacher recertification and/or
salary increases. Official transcripts for current course work can
be printed upon request approximately two weeks after the instructor
submits course grades to the Teacher Enhancement Office. |
If you are faxing this completed form to us, be sure to
include your credit card information below:
Card Type (American Express, MasterCard, Visa):
____________________________________________
Card Number: ________________________________________ Expiration Date:
___________________
Name on card: ________________________________________Amount to be charged:
$____________
If you are mailing this form
to us, be sure to include a check
in the correct amount made out to: CSM Continuing Education. |