"Request for Transcript of Academic Record - Washburn University"

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Request for Transcript of Academic Record
Washburn University
(785) 670-1074
registrar@washburn.edu
Print this form, complete information, provide payment, and return to Washburn University at the address below. Transcripts will not be processed for
students with financial or other unmet obligations to the University.
Personal Information:
____________________________________________
_________________________________________________
Name
(Please Print)
Any other name(s) on record
____________________________________________
_________________________________________________
Street Address
/
Social Security Number
Student I.D. Number
____________________________________________
_________________________________________________
City
State
Zip Code
Date of Birth
(
)_________________ (
)________________
____________________________________________
e-mail
Daytime Phone
Cell Phone
Are you currently enrolled at Washburn?
Yes
No
If no, provide the last year you attended _____________________
Check the statement that applies:
Send transcript(s) now, do not hold
Hold for grades:
)
Fall, Spring, Summer:
(circle
1st 5 wk 2nd 5 wk
8 wk
Hold for degree statement
: Note Degree ________________
Mailing Information:
_________________________________
__________________________________
__________________________________
Attention
Attention
Attention
_________________________________
__________________________________
__________________________________
Institution/Business
Institution/Business
Institution/Business
_________________________________
__________________________________
__________________________________
Street Address
Street Address
Street Address
_________________________________
__________________________________
__________________________________
City
State
Zip Code
City
State
Zip Code
City
State
Zip Code
Please Issue (#) _____ copies.
Please Issue (#) _____ copies.
Please Issue (#) _____ copies.
Payment Information:
Each transcript is $ 8.00
Total transcripts requested _______ x $8.00 = ____________ Total due.
:
Payment by
Check (check #) ________
MC
Visa
Disc : #___________________________________________________
Expiration date_________ Security code_________
Student Signature
Date:
All transcript requests are processed in the order in which they are received regardless of the method by which they are requested.
To request by mail:
Please mail this form and payment to:
Washburn University
Office of the University Registrar
1700 SW College Ave
Topeka, KS 66621
transcript request form 1217.docx (rev.12/17)
Request for Transcript of Academic Record
Washburn University
(785) 670-1074
registrar@washburn.edu
Print this form, complete information, provide payment, and return to Washburn University at the address below. Transcripts will not be processed for
students with financial or other unmet obligations to the University.
Personal Information:
____________________________________________
_________________________________________________
Name
(Please Print)
Any other name(s) on record
____________________________________________
_________________________________________________
Street Address
/
Social Security Number
Student I.D. Number
____________________________________________
_________________________________________________
City
State
Zip Code
Date of Birth
(
)_________________ (
)________________
____________________________________________
e-mail
Daytime Phone
Cell Phone
Are you currently enrolled at Washburn?
Yes
No
If no, provide the last year you attended _____________________
Check the statement that applies:
Send transcript(s) now, do not hold
Hold for grades:
)
Fall, Spring, Summer:
(circle
1st 5 wk 2nd 5 wk
8 wk
Hold for degree statement
: Note Degree ________________
Mailing Information:
_________________________________
__________________________________
__________________________________
Attention
Attention
Attention
_________________________________
__________________________________
__________________________________
Institution/Business
Institution/Business
Institution/Business
_________________________________
__________________________________
__________________________________
Street Address
Street Address
Street Address
_________________________________
__________________________________
__________________________________
City
State
Zip Code
City
State
Zip Code
City
State
Zip Code
Please Issue (#) _____ copies.
Please Issue (#) _____ copies.
Please Issue (#) _____ copies.
Payment Information:
Each transcript is $ 8.00
Total transcripts requested _______ x $8.00 = ____________ Total due.
:
Payment by
Check (check #) ________
MC
Visa
Disc : #___________________________________________________
Expiration date_________ Security code_________
Student Signature
Date:
All transcript requests are processed in the order in which they are received regardless of the method by which they are requested.
To request by mail:
Please mail this form and payment to:
Washburn University
Office of the University Registrar
1700 SW College Ave
Topeka, KS 66621
transcript request form 1217.docx (rev.12/17)