Transcript Request Form - Bay Path University printable pdf download

Office of the Registrar ● 588 Longmeadow Street, Longmeadow, MA 01106

Phone: (413) 565-1222 ● Fax: (413) 565-1108 ●

TRANSCRIPT REQUEST FORM

STUDENT INFORMATION

Transcript requests will only be considered if the Transcript Request Form is completed. Please provide the following

information allowing the Registrar’s Office to match the information on this form with your record in our student

information system. Preferred phone and email will only be used in the event there is an issue with the request.

Name: _________________________________________________________

Birthdate: ______ / ______ / ___________

Former names (if applicable): ______________________________________

Last Four of SSN: _____________________

Preferred Phone: _________________________________

Preferred Email: ____________________________________

INSTRUCTIONS FOR THIS REQUEST

Please complete the following information to assist the Registrar’s Office in processing your request.

Would you like to have the transcript request processed now or

wait for final grades to be posted in your current semester?

______ Now

______ Final Grades

______ Number of transcripts requested to be picked up in Registrar’s Office

______ Number of transcripts requested to be emailed as PDF attachment to the address listed below

Email Address:

_________________________________________________________

______ Number of transcripts requested to be mailed to the address listed below

Recipient:

_________________________________________________________

Street Address: _________________________________________________________

City/State/Zip:

_________________________________________________________

PAYMENT & PROCESSING INFORMATION

Transcript requests will not be processed if there is outstanding financial obligations to the University. Transcripts will be

processed within 1-2 business days after the Registrar’s Office has receipt of payment. Acceptable forms of payment

include cash, check, or credit card. Each transcript will cost $5 if payment is made via cash/check (please make checks

payable to Bay Path University) and $6 if payment is made by credit card. If you are paying via credit card please provide

your card information here.

Name on Credit Card: _____________________________________________ Expiration Date: ______________________

Card Number: ___________________________________________________

3 Digit CVV Code: _____________________

SIGNATURE

Please sign below in pen indicating permission to release your transcript(s). Transcripts will not be processed if the form is

not signed by the student described above or if payment has not been received.

Signature: ______________________________________________________

Date: _______________________________

INTERNAL USE ONLY

Date Payment Rec’d: _________________ Method: ____________ Date Processed: ________________ Initials: _________

Last Update: 4/6/16 MB

Transcript Request Form - Bay Path University

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