Records Release Request

Student Name*

Student ID #*

Street Address*

City*

State*

Zip*

Phone*

Email*

I authorize EGSC to release my information to the following: (Student is responsible for providing complete and accurate information)

Name of Institution*

Attention

Street Address*

City/State/Zip*

Fax #

Institution Email, if applicable

Please indicate Document Needed:*

High School Transcript

Immunization Records

Entrance Scores (SAT, ACT, Accuplacer or Compass)

Unofficial College Transcript (Prior Institution)

Disciplinary Records or Dean’s Letter of Disciplinary Clearance

Instructions*

Mail

Fax

Email

Pick up (Swainsboro campus Only)

Privacy Statement*

Privacy Acknowledge

All personal data and special categories of sensitive personal data collected or processed by East Georgia State College must comply with the EGSC Cybersecurity Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity: https://www.usg.edu/policies. Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to privacy@ega.edu. Otherwise, questions concerning GDPR can be forwarded to privacy@ega.edu. Checking the associated box and submission of this form provides consent to and acknowledgement of the EGSC Data Security and Privacy Policy.

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