Official Co-Curricular Transcript Request Form
Student Email Address: _______________________@unh.newhaven.edu
Name: __________________________________________________
Student ID Number: _______________________________________
Cell Phone: ______________________________________________
Check Method of Delivery - Allow Five Days for Processing:
Pick up at the Office of Student Activities
Please mail to me at:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
City
State
Zip Code
Please review your experiences on Charger Connection before requesting an official copy
of your Co-Curricular Transcript to ensure all involvement information is up to date. For
instructions on how to add experiences and verify your information, please visit
www.newhaven.edu/cct
Signature: ____________________________________________ Date: __________________
Return This Request To:
Office of Student Activities
Bartels Hall – Top Floor
Office Use Only
Request Received:
___ / ___ / ___ ___:___
Request Sent/Pickup: ___ / ___ / ___ ___:___
studentactivities@newhaven.edu
University of New Haven · 300 Boston Post Road · West Haven, CT 06516 · 203-479-4582 · fax 203-931-6037