Official Transcript Request Form

Instructions: Complete this form with all applicable information. Fee payment and student signature are both required

at the time of ordering. If you have any type of hold on your records, your transcript will not be issued. Please note:

transcripts cannot be ordered without a picture ID or written and signed authorization. Only cash, check or money

orders are accepted. Faxed requests are not accepted.

Official Transcript Fees (per copy):

Pickup/US Mail: $5

FAX: $8

FEDEX Domestic: $25

FEDEX International: $50

Student Information:

(*denotes required information for pick-up only requests. For Mail/Fax, all information is required)

*LAST NAME (please print):

*FIRST NAME (please print):

*A#

Email Address:

Street Address:

City:

State:

Zip:

Phone #: (

)

Ext:

Last year enrolled before 1980?  Yes

Date of Birth:

Month / Day / Year

Previous Last Name(s):

Please check at least one:

Special Instructions:

 *Pick up. Number of copies: __________

 *Mail… (indicate to whom and when below)

 *Fax to:

_ Attention:_______________________________

Addresses for Mailed Transcripts:

Please send (enter number) _______ official transcript(s)

to the following address:

______________________________________

 mail now  after final grades for current term

 after degree posts  undergraduate  graduate

Please send (enter number) _______ official transcript(s)

to the following address:

______________________________________

 mail now  after final grades for current term

 after degree posts  undergraduate  graduate

After Grades and/or degree has been posted, please call (435) 797-1786

*STUDENT SIGNATURE:

____________________________________ DATE: ____________________________

(required)

In accordance with the Family Educational Rights and Privacy Act (FERPA) of 1974, your signature is required to authorize the release of your transcripts.

For Office Use Only: Pickup: ______ Mailed: _______ Faxed: ______

Payment received: $ ___________

Date: ________________ Payment Type:  Cash

 Check

Payment received by (staff initials): _____________

Utah State University

Office of the Registrar

1600 Old Main Hill

Logan, UT 84322

(435) 797-1116

07/2010

Official Transcript Request Form - Utah State University

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