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

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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
(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
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
(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
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: ___________________________________