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					Lake Forest Graduate School of Management
Transcript Request Form for MBE Program Application

Note to LFGSM Applicant:

Please complete and sign this form. This form can be completed electronically or printed and then completed by hand
(please print). To complete this form electronically: 1) save the document to your computer, 2) input your information
directly into this form, 3) print, and 4) sign.
Then fax or mail the completed form to the number listed below.

As a convenience to all of our applicants, our admissions office submits the completed form, pays any associated
fees, and arranges for direct receipt of transcripts.

(Please print or type)

Full Name:
               (Last)                                (First)                              (Middle)
Name (While Attending):
                                    (Last)                      (First)                              (Middle)
Social Security Number:                      -   -                            Date of Birth:            /       /
Current Home Address:
City:                                                          State                             Zip:
Daytime Phone:          (       )
Preferred Email Address:

Name of College/University:
City:                                                                     State:
Degree Earned:
Graduation Date:            /           /

Signature (Required):

Note to Registrar:
The person whose information appears above has given written permission for a copy of his or her transcript
to be sent to LFGSM. Please accept any faxed signature as an original. Thank you.

Please fax this form to: 847-576-1213