IDAHO STATE UNIVERSITY

GED Transcript Request

· Mailed transcripts are $5.00 each

TO REQUEST A GED TRANSCRIPT:

1. Mail this signed form (MUST HAVE HAND WRITTEN SIGNATURE) to:
Idaho State University
Counseling and Testing Service
Attn:  GED
Campus Box 8027
Pocatello, Idaho 83209

2. Separate request form for each different address.

3. Please make checks or money orders payable to Idaho State University.

There is no charge for transcripts sent to Idaho state colleges or universities nor correctional agencies

(PLEASE TYPE OR PRINT CLEARLY)

SOCIAL SECURITY NUMBER: ____________-__________-____________ DATE OF BIRTH:_____________________

YOUR FULL NAME: ___________________________________________________________________________________________

(LAST ) (FIRST) ( MIDDLE)

NAME USED WHILE TAKING THE GED TEST: _____________________________________________________________________

YOUR MAILING _______________________________________________________________________________

ADDRESS:

_______________________________________________________________________________

YOUR DAYTIME TELEPHONE NUMBER: (_______) _________-____________ YEAR OF GED COMPLETION: __________

MAIL TO:        ______________

   (# OF COPIES)

NAME: _______________________________________________________________________________________

COMPANY/DEPARTMENT: _________________________________________________________________________

STREET ADDRESS: _______________________________________________________________________________

CITY, STATE, ZIP: _______________________________________________________________________________

SPECIAL INSTRUCTIONS: __________________________________________________________________________

EXAMINEE SIGNATURE: ______________________________________________________ DATE: ________________

(ALL REQUESTS MUST BEAR A HAND WRITTEN SIGNATURE OF THE STUDENT – DO NOT PRINT)