Transcript Request form
Please Note: We are unable to process student
requests if there are any financial obligations owed to the school.
Where do you want your transcript mailed to?
Name ___________________________________________
Mailing Address __________________________________
Address Con’t:____________________________________
City____________________ State____ Zip_____________
What school do you want the transcript from?
School Name_____________________________________
City___________________________ State _____________
Student Name_____________________________________
(be sure to put the name as it was while you attended this school)
Did you graduate from this school? (check) Yes or No
Years Attended ________ through _________
Social Security Number______-_____-______
Student Number (if known)________________
Date of birth_______________________
Number of copies ______
Phone number___________________________
Email address____________________________
Sign ___________________________________ Date ___________
I do herby swear under penalty of the law I am the student and have a legal right to this record.
US Vital Documents Authorization Page
Are you wanting your transcript(circle one) Regular mail or Rush Delivery (FedEx fees apply)
Credit Card Number ___________________________________
Expiration Date____________
Billing info:
Name on Credit Card:______________________________
Street_______________________________
City ______________State __________Zip______
Sign ______________________________ Date________
MUST BE SIGNED BY CREDIT CARD HOLDER
By signing above I understand my credit card will be charged the
Fax to 512-331-8230