Upload
trankien
View
213
Download
0
Embed Size (px)
Citation preview
5/2016
Transcript Request Form This request form is for official transcripts unless otherwise indicated. There is no charge for official transcripts. All obligations to the university must be
cleared before transcripts will be released. Limit of 10 transcripts per day. Please allow 2-3 processing days after receipt of the transcript request for the
transcript(s) to be printed and mailed. The length of processing time does not account for mailing and delivery time to or from the university.
PERSONAL INFORMATION Last Name: ________________________________ First Name: ________________________________ MI: _________ CWID/SSN:________________
Other Names: ______________________________ Date of Birth: _________/________/_________ Phone: ( _______) __________- ____________
Address: _________________________________________________ City: _____________________ State: ________ Zip Code: _________________
Email Address: ________________________________________________________ Please update my address: Yes ______ No ________
TRANSCRIPT REQUEST (CHECK ALL THAT APPLY)
Check all degrees attempted and/or received: _____ Undergraduate _____ Graduate
____ *Pick Up Transcript Qty: ______ ____ Hold for grade change Course: ______________________
____ Mail Transcript ____ Hold for degree posting _____ Spring ____ Summer ____ Fall
____ Unofficial** (faxed ONLY to educational institution) ____ Hold for grade posting _____ Spring ____ Summer ____ Fall
** If requesting unofficial transcript be faxed, please provide fax number: ( ____) _______-________ * Call when ready: _____ Yes _____ No
RECIPIENT MAILING INFORMATION Name: ___________________________________________________ Name: ________________________________________________
Address:__________________________________________________ Address:_______________________________________________
City/State/Zip:_____________________________________________ City/State/Zip:__________________________________________
Quantity: ___________ Quantity: ______________
Signature: ___________________________________________________________ Date: ___________________________________
State law requires that you be informed of the following: 1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few
exceptions as provided by law); 2) you are entitled to receive and review that information; and 3) you are entitled to have the information corrected at no charge to you.
Registrar Office
7101 University Ave- Suite 260
Texarkana, TX 75503
Office: 903-334-6601
Fax: 903-223-3140
Email: [email protected]
Registrar Use Only:
Student ID: ______________________________
Holds: __________________________________
Sys: ____________________________________
Processed by: _______________ Date:________