TRANSCRIPT REQUEST FORM

Name of Applicant:

Mailing Address:

Telephone #: Social Security#:

A#: MEPID#:

Date of Birth: Name of Program Supervisor:

Name of Licensure Sought: Level:

Date of Graduation or Program Completion:

Undergraduate: Graduate:
The Massachusetts Department of Elementary and Secondary Education will not process any paperwork unless the
teacher candidate has applied. It does not connect transcripts to the application if the application is submitted after
the transcripts have been received by the Massachusetts Department of Elementary and Secondary Education.

IT IS IMPORTANT TO APPLY ONLINE BEFORE TRANSCRIPTS AND ENDORSEMENTS ARE SENT

TO THE MASSACHUSETTS DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION BY
THE UNIVERSITY.

If you have NOT applied before the end of the semester, your paperwork will NOT be submitted until you notify
the Coordinator of Teacher Preparation that you have applied. You may reach the Coordinator at the University by
phoning 413-572-8036.

Please forward a copy of my Westfield State University transcript(s) to the licensure officer at Westfield State
University. The transcript(s) will be forward to the Massachusetts Department of Elementary and Secondary
Education once bachelor’s degree (undergraduate) or program completion (post-baccalaureate/graduate) is
posted on the transcript and I have applied online to the Massachusetts Department of Elementary and
Secondary Education.

Signature of Applicant Date

The transcript will be processed once bachelor’s degree (undergraduate) or program completion (post-
baccalaureate/graduate) is posted on the transcript
If you have a bachelor’s degree* or have taken any coursework at another university or
college, you must have an official transcript mailed from that institution mailed to the
Massachusetts Department of Elementary and Secondary Education at:

Office of Educator Licensure

Massachusetts Department of Elementary and Secondary Education
75 Pleasant Street
Malden, MA 02148

*The bachelor’s degree transcript that was submitted for acceptance into the Post-
baccalaureate Teacher Licensure Program must remain in your file. Therefore, another
transcript must be submitted for licensure.

The following information must be submitted by the program supervisor to the licensure officer at Westfield State
University in order to endorse your licensure application:
 The CAP Forms
 The Transcript Request Form (it is the student’s responsibility to have this form ready for the University
supervisor at the last observation meeting)

White copy to Coordinator of Teacher Preparation, yellow to student Revised 1/19