Office of the Registrar                514 University Avenue Selinsgrove, PA 17870-1164                Fax Number: (570) 372-2753

TRANSCRIPT REQUEST FORM

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Submit a separate form for each mail to address. Allow 48-72 hours processing time. Additional time is required for end of semester requests. All financial obligations to the University must be satisfied before the transcript request is released. Transcripts show all work completed at Susquehanna University. Transcripts from other institutions can not be duplicated. A $3.00 charge is applied for all transcripts.

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Student's Name and Current Address:

Date: 

   Check here if you were enrolled during or after Fall 2006.

Dates of Attendance: 

Name used during attendance:

I hereby authorize the release of my transcript to the address shown below.

Signature:______________________________________ Student ID Number:____________________________

Home Phone:                    Work Phone:  

ACTION REQUESTED

Number of Official Transcripts to this address   Number of Unofficial Transcripts to this address

   Send ASAP.   Hold for degree posting.    Hold for end-of-term-grades.   Hold for off-campus credits.

Mail/Fax to (include company/institution name):

OFFICIAL TRANSCRIPTS are printed on security paper and bear the raised seal of the University. This transcript is released to you at the personal request of the person named above. It may not be used for any other reason than that which it was originally provided and it may not be released to anyone outside your own institution or business without written authorization of this individual.

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Last reviewed 11/07/07. Designed by Jon O'Harrow '00. regoffice@susqu.edu, Office of the Registrar. © 1999 Susquehanna University, Selinsgrove, PA 17870-1164. (570) 372-4110 or (570) 372-4109. Fax: (570) 372-2753