GED Transcript Request Form - Ms

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GED Transcript Request Form - Ms Powered By Docstoc
					                                Ms. Amy Heckman, Departmental Analyst
                   Michigan Department of Energy, Labor & Economic Growth (DELEG)
                                  Bureau of Workforce Transformation
                               Division of Lifelong Learning - GED Testing
                               201 N. Washington, Victor Bldg., 2nd Floor
                                            Lansing, MI 48913

                                   Phone: 517.373.1692 - Fax: 517.335.3461

                                        GED TRANSCRIPT REQUEST

                                       REQUIRED INFORMATION

 NAME (maiden name if applicable):_____________________________________________________

 CURRENT ADDRESS:________________________________________________________________

 CITY, STATE, ZIP:___________________________________________________________________

 SS#: ___________________________________                DOB: __________________________________

 DATE/LOCATION TESTING (month/year) if known):_____________________________________

 TELEPHONE NUMBER: (_________________)___________________________________________

 I hereby authorize the Michigan Department of Energy, Labor & Economic Growth, Office of Adult
 Learning - GED Testing, to release my records to the address(es) listed below:

 Signature of Examinee: ______________________________________ Date: ___________________

 NOTE: There is no fee for transcript copies. WE DO NOT FAX TRANSCRIPTS!

 Please allow one week for processing (if prior to 1979, approximately three weeks).

     Examinee request. An official copy of the GED test scores are to be reported to the address
      listed above.

     I would like to have my transcript sent to:

        Name: ________________________________________________________________________

        Address: ______________________________________________________________________

        City, State, Zip: ________________________________________________________________

    Reason for transcript request (mark all that apply):

                Enroll in Technical/Trade Program, Enter 2-Year or 4-Year College or University
                Job Training, get first job or better job, keep current job, or employer requirement
                Military entrance or military career
                Other

NOTE: New forms of the GED tests are expected January 1, 2012. The scores on your test report cannot be
combined with the 2012 series of the GED tests. By December 31, 2011 you must have earned a total passing
score of at least 2,250 (450 average) with no scores less than 410, or you will need to take the entire 2012 series
GED tests.