Transcript Request
Pierce
There is no charge for this service.
Turnaround time is 48 hours upon receipt of fax or mail.
All information must be completely filled in and legible.
Name:
______________________________________________________________
(First)
(Middle)
(Last)
(Maiden)
Birth Date:
Month _______ Day _______
Year ________
Year attended or
graduated: _________________________________
Contact Phone #
(include area code): ______________________________
Requesting the
following records:
_____Transcript
_____ Testing Information
_____ Health Records
Mail Transcript to
#1
Mail Transcript to #2
_______________________________
______________________________
_______________________________
______________________________
_______________________________
______________________________
_______________________________
______________________________
Fax: _____________________________
Fax: _________________________
Attn: _____________________________
Attn:_________________________
Signature: ______________________________________________
For official use
only
Date received:____________________
Date sent: _________________________