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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