Date

PERSONAL INFORMATION

Name

SS# XXX-XX-The last 4 Digits

Date of Birth

Last name if different when attending

Current Street Address

City

State

ZIP

Phone Number

Your email

INFORMATION FOR THE REQUEST

Did you attend ETIATES (you may have to wait a week for ATES)

Year(s) that you attended and/or graduated

Program

Total of transcripts being requested:($20.00 fee for each official transcript and will not be sent until payment is received)

TypeOFFICIALUNOFFICIAL

Complete information for who will be receiving your transcript:

How would you like us to send your transcript?

EmailFAXMail

Name or Department

C/O (Name of Place)

Street Address

City

State

ZIP

Disclosure Statement:

I state the I am the named person above and give my full consent for ETI Technical College of Niles to process this request. I understand that by electronically signing my name below I am fully attesting to this statement and understand that I have the option of completing this form in person at the school located at 2076 Youngstown Warren Road, Niles, OH 44446.

I AgreeI do not Agree

(By selecting "I Agree" and signing below you state you agree to the above statement. Selecting "I Do Not Agree" will cause your transcript request to not be processed.)

Signature

Date signed

ADDITIONAL INFORMATION

What type of schooling are you interested in?

Have you worked in the field that you trained for here? YESNO

We have placement assistance. Would you like to send in a resume? YESNO

Each student whose account is in good standing will be provided an official transcript of record upon completion of his/her program. A charge of $20.00 will be made for each transcript request thereafter. Official academic transcripts will be withheld for failure to pay tuition and outstanding ETI charges, for default on an education debt, or failure to repay an education grant overpayment.

A former student may receive one single copy of an unofficial transcript per FERPA guidelines. It will not be mailed to a third-party such as a prospective employer or to another school. This unofficial transcript will note unpaid financial obligations to the College. No additional unofficial transcripts will be provided so a student should keep a copy of the record. The College will not withhold an official transcript for a student in active bankruptcy or after a discharge of the education debt. For balance information, contact the office at (330) 652-9919.

By providing your information, you consent to being contacted by phone, email, or text message regarding your request.

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