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Fill and Sign the Dlab 1 Rev 212 West Virginia Department of Transportation Division of Motor Vehicles Wv Dmv Medical Review Services Po Box Form

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STUDENT RECORD REQUEST (Please type or print clearly) How to Obtain Your Student Transcript if Your Private Occupational School Closed To request a transcript, please complete, sign and submit this Student Record Request form to the Division of Private Occupational Schools (DPOS) OR the Colorado State Archives. The DPOS transcript request fee is $10.00 (non‐refundable) and should be made payable to “DPOS”. If your transcripts are maintained and located at the Colorado State Archives, please contact the State Archives directly. The State Archives charges students a $15 fee for in‐state residents and a $25 fee for out‐of‐state. Certifications are an additional $10 fee. Transcript Location † DPOS † State Archives – Location Code Student Information Student’s Name (name used when enrolled at the school). Last: First: Social Security Number: Student ID Number: (if applicable) Current Name Last: Current Mailing Address Street: MI: First: MI: City: Day time phone number: State: Zip: Fax number: Student Signature: School Information School Name: School Location: Dates Attended: (Month/Year) Program Enrolled in: Send Transcript To Name and Address (if different from above). Last: First: MI: Mailing Address Street: City: State: Zip: Requested By Name: (please print) Date: Signature: Check/Money Order No.: Division of Private Occupational Schools Colorado State Archives Colorado Department of Higher Education 1313 Sherman Street, Room 1B-20 Denver, Colorado 80203 (303) 866-2390 phone (303) 866-2257 fax http://www.colorado.gov/dpa/doit/archives/ 1380 Lawrence Street, Suite 1200 Denver, Colorado 80204 (303) 866-4187 phone (303) 866-4237 fax

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