Transcript Request Form
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1Transcript Request Form
Office of the Registrar | 601 N. Main St. Mt. Pleasant, IA 52641
Phone: 319-385-6227 | Fax: 319-385-6224 | registrar@iwc.edu
*Social Security # or Student ID#: ________________________________________ Birth Date: _____________________________
*Last Name: _______________________________ *First: _________________________________Middle: ____________________
Previous Names (e.g. maiden name): _____________________________________________________________________________
*Current Full Mailing Address: __________________________________________________________________________________
*Telephone(s): _________________________________________ *Email: ______________________________________________
*Signature:
_____________________________________________________
Date: _____________________
*
(handwritten, not typed)
Please Note:
* required
First year of attendance:
• Your account must be cleared of all holds before your request can be processed.
☐ Yes
☐ No
• Only complete transcripts will be provided. The college does not issue partial records.
Current Student (enrolled now)?
• There is a $10 fee per Transcript. Fees must be received before processing.
☐ Yes
☐ No
• Official Transcripts are mailed first-class USPS mail. Rush orders are $30 in addition to the transcript fee and
Did you graduate from IWC?
will be sent “Second Day” service.
• The normal turn-around time for processing is five (5) to ten (10) working days from the date we receive
☐ Yes
☐ No
your request in our office. However, during busy periods processing time may take longer due to the high
volume of requests.
Please
i ndicate
w hy
y ou
a re
• Transcripts must be requested well in advance to meet deadlines.
requesting
y our
t ranscripts
today:
☐ Pick-up Official ($10) ☐ Mail Official ($10)
☐ Fax unofficial ($10)
☐ Rush two-day ($40)
☐ Graduate School
☐ Employer requested
Transcript Mailing Address
☐ Taking classes elsewhere
*Name of Institution or Recipient: ______________________________________________________________
concurrently
☐ Scholarship
*Department or street address: ______________________________________________________________
☐ Transfer to another institution
Street address: ______________________________________________________________
If
t ransferring,
p lease
c heck
a ll
*City, State, Zip, Country: _______________________________________________________________
that
a pply:
☐ Financial issues
Fax: ____________ -______________- ______________
☐ Program/major not offered
☐ Moving out of the area
Special Instructions:
☐ Hold for Current Semester Grades
☐ Send with additional forms (included by the requester)
☐ Employment Issues
☐ Hold for Degree Entry
☐ Military, BOEE, Scholarship Verification
☐ Denied admission into desired
☐ Pick-up Official ($10) ☐ Mail Official ($10)
☐ Fax unofficial ($10)
☐ Rush two-day ($40)
program
☐ Academic performance
Transcript Mailing Address
☐ Personal or family issues
*Name of Institution or Recipient: ______________________________________________________________
☐ Other:
*Department or street address: ______________________________________________________________
Office Use Only
Street address: ______________________________________________________________
Date Received:
__________________________
*City, State, Zip, Country: _______________________________________________________________
Address: ☐ Updated ☐ Same
Fax: ____________ -______________- ______________
Date Sent: __________________
Special Instructions:
☐ Hold for Current Semester Grades
☐ Send with additional forms (included by the requester)
By: __________
Recorded: ☐
☐ Hold for Degree Entry
☐ Military, BOEE, Scholarship Verification
File #: _______________
☐ Cash ☐ Check /Money Order #_____________
☐ MasterCard
☐ Visa ☐ Discover
Amt. Paid $ _______
Credit Card Number _________________________________________________________________________
Business Hold: ☐ Yes ☐ No
Expiration Date: ___________ / ___________ Security Code ________________ Zip code _______________
Cleared: ☐ Yes ☐ No
Card holder name __________________________________________________ Amount $ ________________
Form TR-2015-v3
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