AUgUSTA
DES MoINES
MASoN CITY
Tel: 207.213.2500
Tel: 515.727.2100
Tel: 641.423.2530
CEDAR FALLS
hAgERSToWN
oMAhA
Tel: 319.277.0220
Tel: 301.766.3600
Tel: 402.431.6100
CEDAR RAPIDS
LEWISToN
RoCkVILLE
Tel: 319.363.0481
Tel: 207.333.3300
Tel: 301.258.3800
DAVENPoRT
LINCoLN
SoUTh PoRTLAND
Tel: 563.355.3500
Tel: 402.474.5315
Tel: 207.774.6126
Student Transcript Request Form — Campuses
Students must submit all Kaplan University official and unofficial transcript requests in writing. Requests are processed in the order of
receipt. All requests should be processed within 7 business days of receipt.
Once this form has been completed and signed, you may fax this form along with your credit card information to the respective school
listed below or call the respective school for mailing information.
Augusta Fax: 207-213-2550
Cedar Falls Fax: 319-268-0978
Cedar Rapids Fax: 319-390-0100
Davenport Fax: 563-355-1320
Des Moines Fax: 515-727-2115
Hagerstown/Rockville Fax: 301-739-7188
Lewiston Fax: 207-333-3305
Lincoln Fax: 402-474-4318
Mason City Fax: 641-423-7512
Omaha Fax: 800-524-9705
South Portland Fax: 207-221-8799
Personal Information
LAST NAME: ______________________________________ FIRST NAME: ______________________________________ MIDDLE INITIAL: _______
NAME(S) WhILE ATTENDINg SChooL: ________________________________________________________________________________________
STREET ADDRESS: ________________________________________________________________________________________________________
CITY: ________________________________________ STATE: ________________________________ ZIP: ________________________________
hoME TELEPhoNE: ________________________________________ EMAIL ADDRESS: ________________________________________________
SoCIAL SECURITY #: ________________________________________ DATE oF BIRTh: ________________________________________________
ShoULD WE UPDATE oUR RECoRDS To REFLECT ThIS ADDRESS? [ ] YES [ ] No
NAME oF SChooL AND/oR DATES oF ATTENDANCE: ____________________________________________________________________________
[ ] Unofficial Transcript
PLEASE RELEASE ____________________ CoPIES oF MY UNoFFICIAL TRANSCRIPTS To EACh oF ThE ADDRESSES BELoW.
[ ] MY CURRENT ADDRESS LISTED ABoVE
[ ] _____________________________________________________________________________________________________________
[ ] _____________________________________________________________________________________________________________
[ ] Official Transcript
Official transcripts are only released if the student has met all financial obligations to the University. There is a $10.00 fee for each copy.
An additional fee of $25.00 is required if rush delivery is requested.
Please attach a check for the total amount required or include your credit card information below.
PLEASE RELEASE ____________________ CoPIES oF MY oFFICIAL TRANSCRIPTS To EACh oF ThE ADDRESSES BELoW.
[ ] MY CURRENT ADDRESS LISTED ABoVE
[ ] _____________________________________________________________________________________________________________
[ ] _____________________________________________________________________________________________________________
Payment Information:
[ ] ChECk/MoNEY oRDER
[ ] VISA
[ ] MASTERCARD
[ ] DISCoVER
[ ] AMERICAN ExPRESS
[ ] PAID oNLINE
CARD #: _________________________________________________ ExPIRATIoN DATE (M/YY): ________________________________________
CARDHOLDER’S NAME: ____________________________________ TOTAL PAYMENT ENCLOSED $:______________________________________
CARDhoLDER’S ADDRESS:_________________________________________________________________________________________________
By signing this form, I authorize Kaplan University to release my transcripts to the parties listed above.
Signature _____________________________________________________________________________________ Date _____________________
* If your name has changed since being enrolled at Kaplan University, you will need to contact us with proper documentation to get your records updated.
KUGC STUD TRAN REQ FORM 09/2013
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