Transcript Request Form printable pdf download

TRANSCRIPT REQUEST FORM

We do not charge for normal processing of transcripts (2-5 business days). A special $9.00 rush charge will be assessed to orders that

require 24 hour processing. Fill out one request for each separate mailing address. Transcripts will be processed in the order they are

received. We cannot accept responsibility for delivery of transcripts once they leave our office. Requests must be made in writing.

Requests from students who have financial holds on a student account will not be processed. If you check the RUSH box below,

payment must accompany your request. Only 3 transcripts can be ordered at one time. We DO NOT fax transcripts.

Mailing Address: FSU and Pierpont, ATTN: Enrollment Services, 1201 Locust Avenue, Fairmont, WV 26554

Fax: (304) 367-4789

REQUESTED INFORMATION

*All information marked with an asterisk (*) is required.

*SS# OR Student ID #___________________________________________ *Date of Birth___________________________________

*Last Name_____________________________________ *First Name_______________________________________ MI__________

Former Name(s) ______________________, _______________________, _______________________, _______________________

Current Mailing Address ________________________________________________________________________________________

City ___________________________________________________ State_______________ Zip Code ______________ - _________

*Telephone Number (________) _________-__________ Email Address_________________________________________________

*Are you currently enrolled at Fairmont State or Pierpont? Yes ⁭ No

*Are you a Fairmont State or Pierpont graduate? Yes No

*If you are not currently enrolled at Fairmont State or Pierpont, enter the last year you attended. ______________________________

*Select the following options: (Failure to check the correct space will result in additional payments for correct transcripts.)

Hold transcript for end of current term grade processing

I will pick up on ____________________

Hold transcript for recent degree

Send transcript immediately

RUSH (Payment MUST accompany request.)

I give __________________________________________, __________________, permission to pick up my requests.

(Name)

(Relationship)

__________ Number of copies requested. (Please complete separate requests for different addresses.)

Mail Transcript(s) to:

___________________________________________________________________ Name/Title

___________________________________________________________________ Institution

___________________________________________________________________ Address

___________________________________________________________________ City/State/Zip

Ο Please include CE courses.

Student’s Signature (required) ___________________________________________________________ Date____________________

AUTHORIZATION TO CHARGE CREDIT CARD

Name on Card

Daytime Phone Number

Amount

(

)

⁭

Address

Visa

MasterCard

Discover

Date

Card #

City, State, Zip

Signature

Expiration Date

Last Updated: 5/11/11

Transcript Request Form

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