Organizational Effectiveness Data Protection

Office of Student Supports and Organizational Effectiveness

Bureau of Health/Nutrition, Family Services and Adult Education The Connecticut Department of Education (SDE)collects, processes, and protects confidential or restricted data pursuant to the requirements of Personal Data Act Conn. Gen. Stat. §4-190 et seq., and the State Policy on Security for Mobile Computing and Storage Devices, and the SDE’s Data Protection Policy and Procedures. REQUEST FOR OFFICIAL GED TRANSCRIPT

THIS FORM CAN BE DUPLICATED

PLEASE PRINT

Name: First Middle Last

(If different from above): Name at the time you took the GED examination First Middle Last

YEAR THAT GED TEST WAS TAKEN: (If not certain, give an approximate year.) LOCATION TEST WAS TAKEN: Last 4-digits of Social Security Number: Date of Birth: Current Address:

Street Apartment or Unit Number

Town State Zip Code

Phone Number: CHECK ONE BOX ONLY

MAIL (Official Transcript)

FAX (Unofficial Transcript)

EMAIL (Unofficial Transcript)

Address:

Name of Institution/Employer

Street Suite Number

Town State Zip Code

Fax Number: Email Address: Signature: Date: Mailing Address: GED OFFICE

Connecticut State Department of Education

450 Columbus Boulevard, Suite 508

Hartford, CT 06103

Phone Number: 860-***-**** or 2110

FAX Number: 860-***-****

Email Address: adz99s@r.postjobfree.com

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