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: _______________