Office Of Student Records Transcript Request Form (Page 3 of 3) in pdf

Official Use Only

GC ID#: ___________

REQUEST FOR TRANSCRIPT

Last Name____________________________________________

First Name _________________________________

MI __________

Previous/Enrolled Name (if different) _______________________________________________ Date of Birth ____________________________

Check to update address:

Current Address ________________________________________

City ______________________

State __________

Zip _____________

Daytime Phone _________________________ E-mail address ________________________________ Soc. Sec. Number ______________________

PROGRAM(S) ATTENDED AT GRATZ COLLEGE

(Example: Cont. Ed, RTC, BRA, Other, MA Ed, JCHS, etc.)

ARE YOU CURRENTLY ENROLLED? [Y/N] __________

IF YOU ARE NO LONGER ENROLLED, PLEASE INCLUDE: Year of graduation/Separation ____________ Degree Received (if any) _______________

CURRENTLY ENROLLED STUDENTS:

If you are requesting Official transcripts, please specify one or more of the following conditions to insure that your transcript is complete prior to

being sent out. Please be advised that these conditions may cause delays in processing and mailing.

Send now (although some grades may be missing)

Fees

Send after __________ semester’s grades are posted

Transcripts Processing (1

transcript)………..…………9.00

__________

Course ID ___________ Section___________ Completion date

Additional transcript (each)………………………….………5.00

Send after graduation has been confirmed (6-8 weeks after commencement)

Express Processing/Walk-ins……….………………..……14.00

Month: _________________ / Year: ____________

Number of Transcripts requested

Shipping Options (in addition to above fees)

Official:

_____

Official – Standard: Up to ten business days……....…Free

Unofficial:

_____

*Unofficial Transcripts free

Official – Express Shipping: Requested by noon……19.99

Total:

_____

Unofficial Standard: Up to ten business days…….…..Free

Mail transcripts to: List additional addresses on reverse, or attach separate page with instructions

________________________________________________

_______________________________________________

________________________________________________

_______________________________________________

________________________________________________

_______________________________________________

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By signing this form you are authorizing Gratz College to release your transcript as indicated above.

•

Transcript request will not be honored if there is a “HOLD” on the account from the Business Office or Library.

•

The college does not fax transcripts and will not be responsible for transcripts after they are mailed.

For Official Use Only:

Amt. Pd. ________________________ Request Rec’d _______________________ Sent _______________________ By _______________________

Batch Number ________________________________________ Check # __________ Check Date_____________ Hold Y/N __________________

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Student’s signature/Date (required): __________________________________________________________

Date: _______________________

We Accept Visa/MasterCard/Discover/Check/Money Order:

Credit Card Number: ______________________________________________ Expiration Date: _____________________ Security Code _________

Office of Student Records, Gratz College 7605 Old York Road, Melrose Park, PA 19027

Telephone: (215) 635-7306 Fax: (215) 635-7399 Toll free: (800) 475-4635

studentrecords@gratz.edu