IUPUI Transcript Request Form

Request for Official Copies of College/University Transcript

This form is provided for your convenience for you to mail or fax to any previous colleges or university which you have attended to request a transcript. These transcripts are necessary to evaluate any courses you completed outside the IU system for possible transfer credit. You must authorize the release of your transcripts to this office. Print and fill out one request for each school that you attended.

Please note: Most colleges and universities require a fee in addition to a written release for your transcript. You should contact them prior to sending this written release to inquire about the cost and specific procedures.

To be completed by applicant:

Last Name: ______________________
First Name: _       Middle Name:
Other Names on Transcripts: ________
Student or Social Security Number:       Date of Birth: _
Dates Attended School: (month/year) From : _ To:
E-mail: ____________________
Home Phone: _      Work Phone: _
Current Address: _________________
City: State: Zip: _
I hereby request that _
Send my Transcript to:

Signature: _ Date: _