Request for Documentation

Request for Documentation
In accordance with the Family Education Rights and Privacy Act of 1974 it is necessary for officials at City College and its agents to have written consent from a student in order to release information from the student's records to any source outside the College, the exception being directory information.

The Request for Documentation form is completed by a student who would like to request a student letter, transcript or to have documentation from an outside agency be completed by the Administrative Office. By completing the form a student provides authorization to City College to disclose the information identified below.

Normal processing time is a minimum of three business days. You will be emailed once your request has been completed.
Student Name*

First NameLast Name
Campus:
Program Name*
Last four digits of your Social Security Number*
E-mail Address*
I would like to request the following: *

Student Letter (PDF Emailed)Unofficial TranscriptComplete the Attached DocumentationRecommendation Letter (PDF Emailed)Complimentary Transcript (within 30 days of Graduation date)Other
Recommendation Letter From:
Name of Employee
Forward documentation to:
Name
Street Address

Street Address Line 2

CityState

Zip Code
Documentation to be Completed:

Documentation must be a scanned PDF, Microsoft Word or Microsoft Excel document, NOT a picture. For a free scanning app for your phone click the link below:

https://acrobat.adobe.com/us/en/acrobat/mobile-app/scan-documents.html
Upload a File

Cancelof
Student's Signature*

Powered by Jotform SignClear
Enter the message as it's shown*
The following notice will be provided to the persons or entities identified above:
The information disclosed to you is governed by the provisions of the Family Educational Rights and Privacy Act. Therefore, the disclosed information may be used only for the purposes identified by the student and may not be re-disclosed to others without specific written authorization from the student.

Administrative Office Use Only
Date Completed:_____________________________
Completed by:_______________________________
Was the student emailed?
Should be Empty: