Official Transcript Request Form
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11420 Aus n Bluffs Parkway
OFFICIAL TRANSRIPT REQUEST FORM
Colorado Springs, CO 80918
FOR STUDENTS WHO ATTENDED
Phone: (719) 255‐3361
BETH-EL COLLEGE OF NURSING PRIOR TO FALL 1997
Fax: (719) 255‐3116
ALL OTHERS, PLEASE USE
ONLINE
ORDERING.
Email:
registrar@uccs.edu
Student Information
Full Name: _________________________________________
Date of Birth: _________
Name While Enrolled: ________________________________
Dates of Attendance: ___________ to ___________
Street Address: ______________________________________
Daytime Phone Number: ______________________
City: ____________________ State: _____ Zip Code: ____________
Email Address: __________________________
$12/
US First Class Mail or Interna onal Air Mail (Please allow 7‐10 business days processing)
copy
$20/
Pick‐Up (Same day processing)
Transcripts will be ready for pickup in Main Hall, Room 108. If a
copy
third party is picking up, please print their name (Photo ID required):______________________
FedEx Express® U.S. Services (FedEx does NOT deliver to P.O. Boxes)
$12/
Delivery Phone Number required: _________________
Deliver without signature
copy
($30 FedEx surcharge applied to orders including this op on)
FedEx Express® Interna onal Services (FedEx does NOT deliver to P.O. Boxes)
$12/
Delivery Phone Number required: _________________
Deliver without signature
copy
($85 FedEx surcharge applied to orders including this op on)
$ 0
Total
I hereby authorize the release of my transcript. I understand that transcripts cannot be issued if a financial hold exists on my account.
______________________________________________________________________
________________________________________
Student Signature
Date
Your request will not be processed without your signature!
Deliver To Address:
Payment Information:
Complete one request form for each addressee.
Check if same as above:
Check: Please make checks payable to: UCCS
________________________________________________________________
________________________________________________________________
________________________________________________________________
Revised 6/2015
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