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TRANSCRIPT RELEASE FORM:

1.    PLEASE READ:  All transcript release forms are subject to the review by the Student Services Coordinator and or the President of the TDLI, before the transcript is released. Please print or type legibly all of the information requested on this form, and enclose the appropriate payment with your request and send it to TDLI via registered express postal mail. Incomplete forms will not be processed.

2. Student Name:  ___________________________________________________

3. ID NUMBER: ____________________ Date: ____________

4. Date of Birth: ____________________________________

5. Last Semester Enrolled at TDLI: _____________________

6. Your Full and Complete Mailing Address: ____________________________________________________________________________________________________________________________________________________________________________________________________________

7. Phone Number Including Country Code, Area Code, & #: ___________________________________________________

8. Cell Phone #: _____________________________________

9. Email: ___________________________________________

10. Reason for Request: ______________________________________________________________________________________________________

11. Where would you like your transcripts mailed to: ____________________________________________________________________________________________________________________________________________________________________________________________________________

12. Number of copies to be sent to this address: _________

13. Official Transcripts: YES: __________ NO: ___________

14. $ 45 CDN Dollars Per Transcript. Total $ _____________

15. Payment Method: Please include check or money order made out to Trafalgar Distance Learning Institute.

For Credit Card Payments Please Print your information here:
Credit Card Type: ___________________________________
Credit Card Number: _________________________________
Exact Name on CC: __________________________________
Three or Four Digit Pin On Back of Card: ________________
Your Signature: _____________________________________
Date: ______________________________________________

You may also phone in your Credit Card Information to us!!
1 403 347 9019, 1 888 686 6163, or 1 403 454 2887.
Presidents Signature and Date: ___________________________________________________

END OF TRANSCRIPT RELEASE FORM.