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Request for Official Transcript The following student is requesting transcripts: Please print all information below; Students Name: ______________________________________ Social Security #: _______________________ Any other names used: _______________________________________ DOB: _________________ Mailing address: _________________________________________ Phone number: _________________________ City: _________________________________ State: ________________ Zip: ___________ Please mark all that apply to you. Far North Bible College Alaska District School of Ministry American Indian College Bethany University 10020 North 15th Ave 800 Bethany Dr. Phoenix, AZ 85021-2199 Scotts Valley, CA 95066 Central Bible College Evangel Bible College 3000 North Grant Ave. 1111 North Glenstone Ave. Springfield, MO 65803 Springfield, MO 65802 North Central University Northwest University 910 Elliot Ave. PO Box 579 Minneapolis, MN 55404 Kirkland, WA 98083 Southeastern University Southwestern AG University 1000 Longfellow Boulevard 1200 Sycamore Lakeland, FL 33801 Waxahachie, TX 75165 Trinity Bible College Valley Forge Christian College 50 Sixth Ave. S. 1401 Charlestown Road Ellendale, ND 58436 Phoenixville, PA 19460 Vanguard University Zion Bible College 55 Fair Drive 320 S Main St. Costa Mesa, CA 92626 Bradford, MA 01835 AG Theological Seminary Global University 1435 North Glenstone Ave. 1211 South Glenstone Ave Springfield, MO 65802 Springfield, MO 65804-0315 Berean School of the Bible Caribbean Theological College 1211 South Glenstone Ave. PO Box 1335 Springfield, MO 65804-0315 Bayamon, PR 00960 Latin American Bible Institute – CA Latin American Bible Institute - TX 14209 East Lomitas Ave. 10822 FM Road 1560 La Puente, CA 91746 San Antonio, TX 78254 Native American Bible College Western Bible College PO Box 248 2601 E. Thomas Road Suite 117 Shannon, NC 28386 Phoenix, AZ 85016 _______________________________ ______________________________ _______________________________ ______________________________ _______________________________ ______________________________ Your signature allows us to request any and all transcripts from the Universities, Colleges, Institutes and District Schools of Ministry you have marked above. You are responsible for any and all cost in obtaining the transcripts from the Universities, Colleges, Institutes, and District Schools of Ministry you have marked above. Your signature also allows the Alaska District Council of the Assemblies of God and the Alaska District School of Ministry to share and exchange any and all information openly and without reservation for the duration of your enrollment in AKSOM and for six months after you have completed your last course. If you wish to revoke this you must put into writing the denial of access to records and it must be on file at both the Alaska District Council Office and AKSOM. Signature: ____________________________________________ Date: ________________________ Guardian: _____________________________________________ Date: ________________________ Only if the student is a minor .

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