Form F-046 "Transcript Request Form - Suny Empire State College" - New York

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Download Form F-046 "Transcript Request Form - Suny Empire State College" - New York

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For Office Use Only
Transcript Request Form
Please print or type
SS # or ID # _____________________________________________________________
Empire State College center attended _________________________________________
Student name
__________________________________________
Payment amount ___________________
(or other names known by)
Current name ____________________________________________________________
Student status _____________________
Street/Apt. _______________________________________________________________
Transcript mailed __________________
City/State/Zip ___________________________________________________________
O/N _____________________________
Email address ____________________________________________________________
Special action _____________________
Check which phone(s) you can be reached at during the day
q Home________________________
q Work ________________________________
q Cell__________________________
IMPORTANT INFORMATION
• Your transcript consists of a cover page, degree program (if approved at the time of the transcript request), narrative evaluations
of each successfully completed study for all terms prior to the November 2011 term and a transcript summary.
• Transcripts are processed in the order in which they are received.
• Please note: official transcripts (enclosed in a sealed envelope) opened prior to being delivered to a third party might not be
considered official.
• No transcript will be furnished to a student or alumnus who has outstanding financial obligations.
• Your first transcript ever requested is free. Each additional transcript is $5 each.
MAIL (check one):
q After my grades are in from my current term of enrollment
q After my degree program has been concurred
q When my degree has been awarded
q Now
PAYMENT OPTIONS
q Check, make payable to SUNY Empire State College
q Money order, make payable to SUNY Empire State College
q Credit card, account #_________________________________________________
Exp. date__________________________
Card holder signature _________________________________________________
Date______________________________
_____ my first transcript ever requested.
_____ number of undergraduate transcripts at $5 each to be sent to the following recipients.
_____ number of graduate (master’s) transcripts at $5 each to be sent to the following recipients.
Enclosed is $_________________________.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Signature ______________________________________________________________
Date______________________________
Transcript will not be released without your signature
Send ______ number of transcripts to the following address:
Send ______ number of transcripts to the following address:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Attach additional pages (for more recipients) if needed.
Mail to: Transcript Request, Office of the Registrar, SUNY Empire State College, 2 Union Ave.,
Saratoga Springs, NY 12866-4390
06102–RC-4
Fax to: Transcript Request, Office of the Registrar, SUNY Empire State College, 518-580-0105
F-046–Rev. 2/2016
For Office Use Only
Transcript Request Form
Please print or type
SS # or ID # _____________________________________________________________
Empire State College center attended _________________________________________
Student name
__________________________________________
Payment amount ___________________
(or other names known by)
Current name ____________________________________________________________
Student status _____________________
Street/Apt. _______________________________________________________________
Transcript mailed __________________
City/State/Zip ___________________________________________________________
O/N _____________________________
Email address ____________________________________________________________
Special action _____________________
Check which phone(s) you can be reached at during the day
q Home________________________
q Work ________________________________
q Cell__________________________
IMPORTANT INFORMATION
• Your transcript consists of a cover page, degree program (if approved at the time of the transcript request), narrative evaluations
of each successfully completed study for all terms prior to the November 2011 term and a transcript summary.
• Transcripts are processed in the order in which they are received.
• Please note: official transcripts (enclosed in a sealed envelope) opened prior to being delivered to a third party might not be
considered official.
• No transcript will be furnished to a student or alumnus who has outstanding financial obligations.
• Your first transcript ever requested is free. Each additional transcript is $5 each.
MAIL (check one):
q After my grades are in from my current term of enrollment
q After my degree program has been concurred
q When my degree has been awarded
q Now
PAYMENT OPTIONS
q Check, make payable to SUNY Empire State College
q Money order, make payable to SUNY Empire State College
q Credit card, account #_________________________________________________
Exp. date__________________________
Card holder signature _________________________________________________
Date______________________________
_____ my first transcript ever requested.
_____ number of undergraduate transcripts at $5 each to be sent to the following recipients.
_____ number of graduate (master’s) transcripts at $5 each to be sent to the following recipients.
Enclosed is $_________________________.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Signature ______________________________________________________________
Date______________________________
Transcript will not be released without your signature
Send ______ number of transcripts to the following address:
Send ______ number of transcripts to the following address:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Attach additional pages (for more recipients) if needed.
Mail to: Transcript Request, Office of the Registrar, SUNY Empire State College, 2 Union Ave.,
Saratoga Springs, NY 12866-4390
06102–RC-4
Fax to: Transcript Request, Office of the Registrar, SUNY Empire State College, 518-580-0105
F-046–Rev. 2/2016