Official Transcript Request
Student Information
S
tudent ID Number: _______________________ SSN
(If Student ID Number not known): ____________________________
Name: ____________________________________________________________________________________________
Last First M.I. Other Last Names
B
irth Date: ____________________ Years attended: _______ to _______
(YYYY) (YYYY)
C
urrent Address: ____________________________________________________________________________________
Street City State ZIP Code
Contact Information
T
elephone: _______________________________ *Email Address: _____________________________________________
*
By including an email address, you will receive automated updates from Credentials, Inc. regarding the status of your request.
Basic Order Information
Normal Processing: □ Deliver to Recipient □ Pick Up*
$5.00 per copy after first 2 ever ordered.
Rush Processing: □ Deliver to Recipient □ Pick Up* □ Hand-Carry (In-person request)
$10.00 per copy. Allow one business day for processing for Deliver to Recipient and Pick-Up requests. Deliver to Recipient requests sent
by 1st Class Mail.
Hold for Final Grades:
□ Summer □ Fall □ Spring
Hold for Degree:
□ Summer □ Fall □ Spring
Hold for Grade Change:
□ Summer _____ □ Fall _____ □ Spring _____ Course: ______________________________
*If applicable, I authorize the following person to pick-up my transcript (s):
S
pecial Instructions: _____________________________________________________________________________________
Recipient 1
Number of Copies: _____
Recipient 2
Number of Copies: _____
Student Signature: ________________________________________ Date: ____________________
Staff Use Only Received By & Date: _______________ Paid Amount: $______
Entered into System: _________________ Order # _______________
