"Transcript Request Form - Baylor College of Medicine" - Houston, Texas

Download "Transcript Request Form - Baylor College of Medicine" - Houston, Texas

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OFFICE OF THE REGISTRAR

Transcript Request

You must print the form and follow the directions below. Leaving requested information blank may result in processing delays.

This is not an electronic form. If you are requesting more than two transcripts, please attach an additional sheet.

Please allow 2 business days, once received in our office for processing. To receive a transcript, you must not have an

outstanding balance.

STUDENT INFOMRATION

BCM ID Number: ___________________

Dates of attendance: ____________________________________________

Academic Program:____________________________

First month/year

Last month/Year

(MD, GRAD, AH, Tropical Medicine)

Last Name: _______________________ First Name: _______________________________ Middle Initial: ____________________

Date of Birth: ___________________________

Other Names/Maiden Name: _________________________________

Current Street Address: ________________________________________________________________________________________

City: ____________________________ State: ____________________________ Zip Code: _______________________________

Telephone Number: _______________________________ Email Address: ______________________________________________

TRANSCRIPT HANDLING INFORMATION: Please note, transcripts picked up by the student are stamped “Issued to Student.”



 Mail

 Student pick up

Mail

Student pick up

)

(Please complete the address information

Number of Copies: ______

_______

Number of Copies: _______

_______

Official (sealed envelope)

Unofficial

Official (sealed envelope)

Unofficial

Mail To: Address 1

Mail To Address 2:

___________________________________________

__________________________________________________

___________________________________________

__________________________________________________

__________________________________________

__________________________________________________

__________________________________________

__________________________________________________

City

State

Zip

City

State

Zip

Select one: Hold for grades Hold for degree

Student Signature: _______________________________________________________ Date: _______________________________

Your signature on this form authorizes the release of your transcript as well as our ability to communicate with you about this request via e-mail or phone. Forms

without signatures will not be processed. Students are responsible for providing accurate address information for recipients.

Submit completed request to the Office of the Registrar

One Baylor Plaza M210, Houston, TX 77030

Fax: (713) 798-1518

Email:

registrar@bcm.edu

For Office Use Only: Date Received/Initials: _____________________________

Student Initials if picked up: ___________________

Date Processed/Initials: ____________________________

Date: ___________________________________

OFFICE OF THE REGISTRAR

Transcript Request

You must print the form and follow the directions below. Leaving requested information blank may result in processing delays.

This is not an electronic form. If you are requesting more than two transcripts, please attach an additional sheet.

Please allow 2 business days, once received in our office for processing. To receive a transcript, you must not have an

outstanding balance.

STUDENT INFOMRATION

BCM ID Number: ___________________

Dates of attendance: ____________________________________________

Academic Program:____________________________

First month/year

Last month/Year

(MD, GRAD, AH, Tropical Medicine)

Last Name: _______________________ First Name: _______________________________ Middle Initial: ____________________

Date of Birth: ___________________________

Other Names/Maiden Name: _________________________________

Current Street Address: ________________________________________________________________________________________

City: ____________________________ State: ____________________________ Zip Code: _______________________________

Telephone Number: _______________________________ Email Address: ______________________________________________

TRANSCRIPT HANDLING INFORMATION: Please note, transcripts picked up by the student are stamped “Issued to Student.”



 Mail

 Student pick up

Mail

Student pick up

)

(Please complete the address information

Number of Copies: ______

_______

Number of Copies: _______

_______

Official (sealed envelope)

Unofficial

Official (sealed envelope)

Unofficial

Mail To: Address 1

Mail To Address 2:

___________________________________________

__________________________________________________

___________________________________________

__________________________________________________

__________________________________________

__________________________________________________

__________________________________________

__________________________________________________

City

State

Zip

City

State

Zip

Select one: Hold for grades Hold for degree

Student Signature: _______________________________________________________ Date: _______________________________

Your signature on this form authorizes the release of your transcript as well as our ability to communicate with you about this request via e-mail or phone. Forms

without signatures will not be processed. Students are responsible for providing accurate address information for recipients.

Submit completed request to the Office of the Registrar

One Baylor Plaza M210, Houston, TX 77030

Fax: (713) 798-1518

Email:

registrar@bcm.edu

For Office Use Only: Date Received/Initials: _____________________________

Student Initials if picked up: ___________________

Date Processed/Initials: ____________________________

Date: ___________________________________