Official Transcript Request Form

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					This Official Transcript Request Form is completed by the person who completed an
educational program. The form asks basic information about the requestor such as:
name, address, student ID number, dates attended, whether requestor is a current
student or graduate, and whether or not the transcript will be picked up in person by the
requestor, or if it should be sent to a specific address. This document in its draft form
contains numerous of the standard clauses commonly used in this type of form;
however, additional language may be added to allow for customization to ensure the
specific language of the user is addressed. Use this form to request transcripts from a
university or college.
                                     OFFICIAL TRANSCRIPT REQUEST FORM




Mail to:
[College Name]                                                          Signature and Date
[Department Name]
Attn: Transcripts                                                       _________________________________
[Address]


 __________________________________________________                              ________________________________
Last Name,           First,          Middle                                      Student ID #
__________________________________________________                               ________________________________
Former name if applicable                                                        Phone #
__________________________________________________                               ________________________________
Address                                                                          E-mail address
__________________________________________________                               ________________________________
City, State, Zip                                                                 Date of Birth



COMPLETE A SEPARATE FORM FOR EACH PROGRAM ATTENDED: Circle applicable category.


Dates Attended: Current Student _______________; Graduated________________; Degree ______________________



Pick Up transcripts: circle ….. YES                                SIGNED & SEALED ENVELOPES: Failure
                  OR                                               to include this is NOT subject to replacements.
Mail Transcripts to the following addresses:                       Circle one:        YES            NO

    A. (# OF TRANSCRIPTS)____                                  C. (# OF TRANSCRIPTS) ____
    _______________________________                            ________________________________
   __________________________                                  ___________________________
   __________________________                                  ___________________________
   __________________________                                  ___________________________
    B. (# OF TRANSCRIPTS)____                                  D. (# OF TRANSCRIPTS)____
    __________________________                                 ___________________________
    __________________________                                 ___________________________
    __________________________                                 ___________________________
    __________________________                                 ___________________________
                           TOTAL NO. OF TRANSCRIPTS ORDERED ________

Signature: I authorize the release of my academic records to the individual/institution:

Signed: _____________________________ Date: _________________________________



Transcripts are $_____ each. Payment must accompany each order. Fees cannot be charged to term bill or credit card. Checks made
payable to [Name] or cash ONLY. When picking up a transcript you MUST show a photo ID.
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Description: This Official Transcript Request Form is completed by the person who completed an educational program. The form asks basic information about the requestor such as: name, address, student ID number, dates attended, whether requestor is a current student or graduate, and whether or not the transcript will be picked up in person by the requestor, or if it should be sent to a specific address. This document in its draft form contains numerous of the standard clauses commonly used in this type of form; however, additional language may be added to allow for customization to ensure the specific language of the user is addressed. Use this form to request transcripts from a university or college.