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Unformatted text preview: TRANSCRIPT REQUEST _________________________________________________________________________ Your Name __________________________________________________________________________________ Your Street Address __________________________________________________________________________________ Your City, State, and Zip Code __________________________________________________________________________________ Your Daytime Telephone Number and E-Mail Address ________________________________________ Your Student Identification Number _____________________________________ Date of Birth INSTRUCTIONS FOR PROCESSING TRANSCRIPT: If transcript(s) is a pick up or will be mailed to the student, mark this box if transcript(s) should be issued in individually sealed envelope(s) with the Registrar's signature across the flap of the envelope. Send transcript(s) by express mail. By checking this box you agree to pay the current Express Mail rate ($16.25 as of May 14, 2007) in addition to the $5.00 transcript fee. Express mail rates for delivery outside the United States vary. Postal rates are subject to change. Check with the U.S. Postal Service for the exact charge. TRANSCRIPT FEE IS $5.00 PER TRANSCRIPT. Please allow a minimum of 5 working days for processing. The transcript fee should be paid at the Bursar's Office. Financial obligations to the University must be paid at the Bursar's Office before transcripts can be issued. Mark only one of the following: Request will not be honored unless all required information on this form is completed. Process now Process after final grades: __________________ Term ____________ Yr. Transcripts issued to student will bear the notation "Issued to Student". If multiple transcripts are requested to the same recipient, they will be issued in one envelope If you submit your transcript request by fax, you should submit payment by check or money First Term Enrolled: _________________________________________ Last Term Enrolled: _________________________________________ Your Signature: ____________________________________________ Request will not be filled unless this form is signed. Total Number of transcripts requested: _________ Process after degree award: __________________ Term ____________ Yr. unless you indicate in the Instructions for Processing Transcript section that you wish to have the transcripts issued in individually sealed envelopes. Process after grade change: Course Number: _________________________ __________________ Term ____________ Yr. Order payable to SIUE to the Office of the Bursar at the address shown with a note indicating Your payment is for a transcript request submitted by fax. Mail with payment to: Office of the Bursar Rendleman Hall Room 1101 6 Hairpin Dr., P.O. Box 1042 Edwardsville, IL 62026-1047 Fax Number: (618) 650-3332 or 650-2081 Total charge @ $5.00 per copy: _________ Mark only one of the following: I will pick up. Allow 3 working days for processing. You must show a picture ID to pick up your transcript at the Service Center, Rendleman Hall Room 1309. Mail transcripts to the following recipient at the following address (one addressee per form): __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ ...
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This note was uploaded on 06/14/2008 for the course BURSAR Transcript taught by Professor Transcriptapplication during the Spring '08 term at Southern Illinois University Edwardsville.

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