Official Transcript Request Form
516 Brookmere Avenue
Coquitlam, British 
Columbia
Canada
V3J 1W9
Fax: (604) 939-0336  
Email: admiss@coquitlamcollege.com



Student Number*: ____________________
*Missing Student Number may result in processing delay or issuing of incorrect 
transcript.

Full Name: _____________________

Telephone: _________________________

Number of Copies Required: _______
First Copy: $5.00.
Each Additional Copy: $3.00.

Transcript Type
University Transcript Only  (  )
Transcript for All Programs (ESL, SS, UT) (  )

Delivery Method
Pick Up (  )
Mail (  )

Mail Address: _________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Payment
Cheque Enclosed (  )

Credit Card (Visa Only)

Name on Card: _______________________________
Card Number: ________________________________
Expiry Date (YY/MM): __________________________

Signature: ___________________________________

Date: ________________


Please allow two days to process request upon receipt of payment.