West Virginia State University - Transcript Release Form
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1Please send your signed and completed form via fax to 800-473-2512
Please note: Some institutions may require the student to obtain transcripts directly;
if this is the case, your enrollment counselor will contact you.
West Virginia State University: Transcript Release Form
TRANSCRIPT RELEASE AUTHORIZATION
I authorize my official transcripts to be sent to West Virginia State University C/O The Learning House and
allow any necessary follow-up to acquire said transcripts listed below.
Applicant’s Signature: _______________________________________________________
Date: _____________________________
________________________ _______________________ ________________________ _____________________
Legal Name:
First
Last
Maiden
other
_______________________________________ _______________________ _________ _____________
Permanent Address:
Street
City
State
Zip
_____ /_____ /_____
_______ – ______ – __________
Date of Birth:
Social Security Number or Student ID Number:
___________________________________
______________________________________________________
Phone:
Email:
_________________________________________________________________________________________
1. Institution Name:
_______________________________________________________ ____________ ______________________
Mailing Address:
City
State
Zip
_________ to: _________
______________________
Dates Attended From:
Degree Earned/ Program Seeking (if any):
_________________________________________________________________________________________
2. Institution Name:
_______________________________________________________ ____________ ______________________
Mailing Address:
City
State
Zip
_________ to: _________
______________________
Dates Attended From:
Degree Earned/ Program Seeking (if any):
_________________________________________________________________________________________
3. Institution Name:
_______________________________________________________ ____________ ______________________
Mailing Address:
City
State
Zip
_________ to: _________
______________________
Dates Attended From:
Degree Earned/ Program Seeking (if any):
Have more schools for us to request? Please use additional sheets.
Return official transcript materials to:
West Virginia State University
C/O The Learning House
801 East Park Drive, Suite 105
Harrisburg, PA 17111
Or email if using secure service
Institution Records Office: If you cannot process this request, please contact the Transcript Office at 800-293-7075 ext. 175
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