"Transcript Order Form - University of Hawaii at Manoa"

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University of Hawaiÿi at Mänoa
TRANSCRIPT ORDER FORM
Office of Admissions & Records
All outstanding financial obligations to the University of Hawaiÿi must be cleared before
2600 Campus Road, Room 001
transcript requests will be processed.
Honolulu, HI 96822
Ph: (808) 956-5562
Fax: (808) 956-7830
In-person requests: QLC 105 or QLC 010
STUDENT INFORMATION – Required to identify your record (Please Print)
Full Name (Last, First, Middle)
Other name(s) used
Street Address
City
State
ZIP Code
Country
UH Number or Social Security Number
Date of Birth
First Term Attended
Last Term Attended
Phone
Email Address
A. I would like to order:
______ (Qty)
Regular $5.00 per copy (processed within 5 business days after receipt of this request, excluding delivery time).
______ (Qty)
Rush fee $15.00 per copy (processed within 2 business days after receipt of this request, excluding delivery time).
B.
Hold order instructions – optional (Transcripts are sent now unless indicated below)
Send after ________________________ semester grades are posted (Allow 2 -4 weeks after end of semester)
Send after ________________________ semester “degree awarded” notation is posted (Allow 8-10 weeks after conferral date)
C. Indicate special handling - optional
Attach separate document
Other _______________________________________________________________________________________________________
Send transcript(s) to:
Enter name and address of recipient. If requesting to pick up, enter your name and
“Student Pickup.” You must present a valid photo ID when picking up your
transcript.
Unclaimed or undeliverable transcripts will be destroyed after 30 days. No refund
will be issued.
All transcripts released to the student will be stamped “ISSUED TO STUDENT.”
Student’s Signature: __________________________________________________________________________
Date ____________________
Authorization Signature Required: I authorize release of my transcript as directed on this Transcript Order Form.
PAYMENT INFORMATION
Student
(orders with insufficient payment will not be processed)
Name:_________________________________
Enclose check or money order (payable to the University of Hawaiÿi) for mailed
UH Number or SSN: _____________________________
requests or complete payment information below for mailed or faxed requests.
Card Holder’s Name
Credit Card Number
Exp Date (mm/yy)
/
Authorized Amount to Charge
Circle Card Type:
VISA
MasterCard
Card Holder’s Billing Address (include Zip code)
Card Holder’s Phone Number
Card Holder’s Signature (required for credit card payment): _________________________________________________________________________
Official Use Only:
Account Clear By: ________________________
Date Processed:______________________
Cash ______ Check _______
Official Use Only:
Receipt of Cash Payment (UH Mänoa Transcript Request)
Student Name:
__________________________________________
UH Number or SSN: __________________________
Amount: ___________
Date: ________________
Received By: _____________________________________________
University of Hawaiÿi at Mänoa
TRANSCRIPT ORDER FORM
Office of Admissions & Records
All outstanding financial obligations to the University of Hawaiÿi must be cleared before
2600 Campus Road, Room 001
transcript requests will be processed.
Honolulu, HI 96822
Ph: (808) 956-5562
Fax: (808) 956-7830
In-person requests: QLC 105 or QLC 010
STUDENT INFORMATION – Required to identify your record (Please Print)
Full Name (Last, First, Middle)
Other name(s) used
Street Address
City
State
ZIP Code
Country
UH Number or Social Security Number
Date of Birth
First Term Attended
Last Term Attended
Phone
Email Address
A. I would like to order:
______ (Qty)
Regular $5.00 per copy (processed within 5 business days after receipt of this request, excluding delivery time).
______ (Qty)
Rush fee $15.00 per copy (processed within 2 business days after receipt of this request, excluding delivery time).
B.
Hold order instructions – optional (Transcripts are sent now unless indicated below)
Send after ________________________ semester grades are posted (Allow 2 -4 weeks after end of semester)
Send after ________________________ semester “degree awarded” notation is posted (Allow 8-10 weeks after conferral date)
C. Indicate special handling - optional
Attach separate document
Other _______________________________________________________________________________________________________
Send transcript(s) to:
Enter name and address of recipient. If requesting to pick up, enter your name and
“Student Pickup.” You must present a valid photo ID when picking up your
transcript.
Unclaimed or undeliverable transcripts will be destroyed after 30 days. No refund
will be issued.
All transcripts released to the student will be stamped “ISSUED TO STUDENT.”
Student’s Signature: __________________________________________________________________________
Date ____________________
Authorization Signature Required: I authorize release of my transcript as directed on this Transcript Order Form.
PAYMENT INFORMATION
Student
(orders with insufficient payment will not be processed)
Name:_________________________________
Enclose check or money order (payable to the University of Hawaiÿi) for mailed
UH Number or SSN: _____________________________
requests or complete payment information below for mailed or faxed requests.
Card Holder’s Name
Credit Card Number
Exp Date (mm/yy)
/
Authorized Amount to Charge
Circle Card Type:
VISA
MasterCard
Card Holder’s Billing Address (include Zip code)
Card Holder’s Phone Number
Card Holder’s Signature (required for credit card payment): _________________________________________________________________________
Official Use Only:
Account Clear By: ________________________
Date Processed:______________________
Cash ______ Check _______
Official Use Only:
Receipt of Cash Payment (UH Mänoa Transcript Request)
Student Name:
__________________________________________
UH Number or SSN: __________________________
Amount: ___________
Date: ________________
Received By: _____________________________________________