For Office Use Only:
Date Rec’d ____________________ Date Sent ____________________ Payment ____________________ |
Monmouth
College
Office of the Registrar
Transcript Request Form
(Print this page for use in person, by regular mail,
or by fax)
Payment for transcripts can be made
online, but we must receive
an official transcript request by postal mail or fax that includes your signature to release
your records.
Your Information:
Name_____________________________________________________________
Maiden
Name______________________________________________________
Street ____________________________________________________________
City ________________________________ State_________________________
Zip_________________ Phone ________________________________________
Email______________________________________________________________
Student ID ________________________ Or SSN ________________________
Year of graduation or last year attended _________________
Where transcript is to
be mailed (if different address than home address):
Name
____________________________________________________________
Street ____________________________________________________________
City ________________________ State__________________ Zip___________
I authorize Monmouth College to send my transcript as indicated above.
Your Signature
___________________________________________________
Date _____________________________________________________________
_______ Number of copies
_______ Issue immediately
_______ Hold until grades for
current semester are posted
_______ Hold until my degree
appears on the transcript
_______ My check is enclosed
payable to Monmouth College.
(Cost of transcripts is $3.00 per copy.)
_______ I
have paid the fee through the Pal-Pal online service.
(Cost of transcripts is $3.00 per copy.)
Note: If you have
outstanding financial obligations to Monmouth College your transcript cannot be released until
your obligation is met.
Please print this page and
then fax, mail or bring this form to:
Office of
the Registrar - Poling Hall, 2nd Floor
Monmouth College
700 E. Broadway
Monmouth IL 61462
Phone: (309) 457-2326 Fax: (309) 457-2235 |
