Fillable Transcript Request Form - Liberty University Registrar printable pdf download

Transcript Request Form

Name:________________________________________________________________________________________________________________

First

Last

Middle

Student ID#__________________________ Last Four Digits of SSN: _________________ Birth date: _____________________

Address:________________________________________________________________________________Phone#_____________________

Send transcripts to:

______________________________________________________

Number of copies: __________

Expedited FedEx Shipping* (optional)

Expedited FedEx Shipping*(optional)

Official transcript(s)

Unofficial transcript(s)

Required Student Signature for Release of Transcripts-

Student’s Signature:_____________________________________________________Date:_____________

By signing this form you authorize the LU Registrar’s Office to send your transcript(s) to the designated person(s) or organization(s) listed above.

Please check here if you serve/served in the U.S. Military

The transcript fee is waived for all military members (active duty, discharged, retired, etc.).

This policy does not apply to military spouses or dependents.

If FedEx shipping is requested, the student must provide payment to cover the FedEx shipping charge.

Payment- Official transcripts are $10 for the first copy and $1 for each additional copy on the same request (this price

Payment Information:

applies to electronic, official transcripts, as well as hard copies of transcripts). Unofficial transcripts are free.

*Expedited FedEx Shipping - Additional fee of $20 per mailing address in addition to the transcript fee. USA Street

addresses only. FedEx shipping is not available for international, PO Box or APO addresses.

Credit Card #: ________________________________________________ Expiration Date: _____________ Billing zip code: _____________

Pay by credit card:

~We also accept payment by check, money order or cash if you mail your request to our office.~

If you prefer to pay over the phone with a credit card, you may call our office at (434) 582-2000 or toll free (888) 632-5551.

Registrar's Office

Fax: (434) 582-2187

Submit Completed Form To:

Please be sure to sign the form above before submitting it.

1971 University Blvd, MSC Box 71077

Email: LUTranscripts@Liberty.edu

Lynchburg, VA 24515

Rev: 4/16

Transcript Request Form - Liberty University Registrar