Fillable Transcript Request Form printable pdf download

The University of Virginia’s College at Wise

Transcript Request Form

ATTN: Office of the Registrar, 1 College Avenue, Wise, Virginia 24293

Phone: 276‐328‐0117 Web:

______________________________________________________________________________

First Name

Middle Name

Last Name

Student ID or SSN

______________________________________________________________________________

Any former name(s)

Birth Date

______________________________________________________________________________

Current Address

City

State

Zip

______________________________________________________________________________

Phone Number

Email Address

Last session attended: YR________ TERM________  CURRENTLY ATTENDING

Number of OFFICIAL Copies Requested: _____ Number of UNofficial Copies Requested: _____

 Process Now  Hold for Grades  Hold for Degree Posting



I authorize UVa‐Wise to release my official transcripts to the address(es) below:

Address 1 ‐‐ Name and complete mailing address:

________________________________________________________________________________________

Address 2 ‐‐ Name and complete mailing address:

________________________________________________________________________________________

Address 3 ‐‐ Name and complete mailing address:

________________________________________________________________________________________

Address 4 ‐‐ Name and complete mailing address:

________________________________________________________________________________________

SIGNATURE REQUIRED ON REVERSE SIDE

Please use an additional form for more than four addresses.

Transcript Request Form