500 Hour Records Request Form

First Name(Required)

Last Name(Required)

Name during enrollment (if different):

Email(Required)

Phone(Required)

Billing Address(Required)

Address City State ZIP Code

Program Start Date:

Month(Required)

Year(Required)

Please enter a number greater than or equal to 1900.

Documents requested: Please check all that apply.

Transcript

Program/School Information

*Please specify information needed:

Degree Audit

Additional Forms*

Please specify which additional forms need to be completed by the school.

Should you need additional forms completed by the school, you must supply them to the Administrator. Please email Student Administrator, Tila Tapp, at tilat@tlcschool.com with any additional documents needing to be filled out.

I understand that it is my responsibility to supply the school with any outside forms to be completed if I require them.

Use the same shipping address as on the billing address.

Please fill out shipping information if different from the billing address.

Business Name:

Contact/Attn to Name:

Address 1

Address 2

City

State

Zip / Post Code

Records processing is $10 per program. Each records request is considered a separate processing fee.

You will be redirected to payment through MINDBODY after submitting your registration.

If you wish to make a credit card payment by phone, please call 512-374-9222 ex11 during business hours.

Processing of the Records Request Form(s) will not begin until paid in full. Processing and shipping takes between 7-10 business days.

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500 Hour Records Request Form