Hollins University Transcript Request by jgk70530

VIEWS: 32 PAGES: 1

									Date Requested ___________________                     Hollins University                Date Needed ___________________
                                                        Transcript Request

Last Name _______________________________________ First Name _____________________________ MI ______
Home Address _______________________________________________________________________________________
SSN _________________________________ Class Year __________ Major ____________________________________
Name while attending (if different from above) ______________________________________________________________
Telephone ________________________________________ E-Mail ____________________________________________
****************************************************************************************************
Mark appropriate degree level(s):           □ Undergraduate      □ Graduate
****************************************************************************************************
Federal law (The Family Educational Rights and Privacy Act of 1974, as amended) REQUIRES indication of the reason that
you are requesting this transcript, so please check below:
        □ Transfer Purposes                □ Graduate School Application             □ Summer School Application
        □ Employment                       □ Other (please explain) _________________________________________
****************************************************************************************************
Transcripts are $5.00 each. Please check below:
        □ Cash                    □ Check         □ Charge to my account (enrolled students only)
        □ Charge Card*: MC, VISA, Discover, AmEx ___________________________________ Exp Date ___________
*REQUIRED - Billing Address: ________________________________________________________________________
****************************************************************************************************
    Hold for               Number of Copies                                    Mail As Indicated
    Pick-Up                  Requested
                                                         __________________________________________________________
                                                         __________________________________________________________
                                                         __________________________________________________________
                                                        __________________________________________________________


                                                         __________________________________________________________
                                                         __________________________________________________________
                                                         __________________________________________________________
                                                         __________________________________________________________


Please submit additional addresses on a blank second page.           **WE DO NOT FAX TRANSCRIPTS**

STUDENT SIGNATURE: _____________________________________________________________________

Send requests to:
Hollins University Registrar’s Office
PO Box 9708, Roanoke, VA 24020
Phone (540) 362-6311       Fax (540) 362-6690
                                                                                                             Rev. 07/31/2008
                                                                                                                   TransReq

								
To top