Form Rgr-196-414 - Request For Transcript - Florida Institute Of Technology
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1REQUEST FOR TRANSCRIPT
DATE ___________________________________ STUDENT ID NO. _________________________________ DAYTIME TELEPHONE ____________________________
NAME UNDER WHICH YOU ATTENDED _________________________________________________________ DATE OF BIRTH _________________________________
Please Print
Last
First
CURRENT NAME _________________________________________________________________ Signature _______________________________________________
o
o
No. of copies _________________________
Hold for current grades
Hold for degree
o
o
$10 per copy ____________________ paid
Send now
Date Florida Tech degree was or will be awarded ___________________
Month/Year
o
o
I have included an attachment
Will pick up (photo ID required)
Transcripts will not be released to anyone whose financial obligations have not been satisfied. Transcripts cannot be released without student’s signature.
Transcripts will not be sent without receipt of full payment for transcript.
MAIL TO _______________________________________________________
STUDENT __________________________________________________________
_______________________________________________________________
NAME _____________________________________________________________
_______________________________________________________________
ADDRESS __________________________________________________________
_______________________________________________________________
__________________________________________________________________
_______________________________________________________________
PHONE ____________________________________________________________
Students who attended Florida Tech before Fall 1981 must order transcripts by filling and returning/faxing this form,
rather than by electronic request through the Florida Tech PAWS Web site, (login required).
o
o
o
o
o
METHOD OF PAYMENT AMOUNT $ ________________
CHECK ENCLOSED
CREDIT CARD
MasterCard
Visa
American Express
o
o
DELIVERY METHOD
Standard Mail (included in fee)
Overnight (additional fee will apply)
Name on card ___________________________________________________
Credit Card No. ________________________________________________________
Credit Card Billing Address _____________________________________________________________________________________
CV No.* __________________
Signature ____________________________________________________________________________________________________
Exp. Date ________________
*CV No. is the 3-digit security number on reverse of credit card
SPECIAL INSTRUCTIONS
OFFICE USE ONLY
o
o
04 HOLD
Yes
No
SPAIDEN—Update Address ____________________
Date Mailed _________________________________________
o
o
SOAHOLD ______________________
RSIAREV ____________________
Cannot release—Date notified ______________________
By phone
By mail
Florida Institute of Technology • Office of the Registrar
150 West University Boulevard, Melbourne, FL 32901-6975 • (321) 674-7402 • Fax (321) 674-7827
RGR-196-414
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