Transcript Authorization Form

Transcript Authorization Form

Please complete this form to authorize the release of your academic transcript.

Student Information

Name

    Student ID

      Program

        Major

          Receiver Information

          Name

            Email

              Address

                Mode of Receiving

                  • Pick-Up

                  • Email

                  • Mail

                  Reason for Request

                    EmploymentGraduate School ApplicationTransfer to Another InstitutionPersonal RecordsScholarship ApplicationVisa or ImmigrationCertification or LicensingMilitary ServiceInsurance Purposes

                    Authorization

                    I authorize the release of my academic Transcript of Records to the recipient listed above. I understand that this authorization is voluntary and can be revoked at any time by contacting [Your Company Name].

                    Name:

                    Date:

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                    Thank you for submitting this form.

                    We will notify you once the transcript has been sent.

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