National College Credit Recommendation Service (Nccrs) Application Form (Page 2 of 2) in pdf

Payment

(If fees paid by student)

If your sponsoring organization is not covering the fee to post credit on an Excelsior College transcript, be sure to

include payment. The fee for each transcript is $40. Make your check or money order payable to Excelsior College.

Payment in full is attached (check, money order, or completed charge authorization)

Credit Card Authorization

I authorize Excelsior College to charge ___________ (or current NCCRS listing fee at the time this form is received by

Excelsior College) to my:

MasterCard

Visa

Discover

American Express

Credit Card Account Number ___________________________________________________________

Expiration Date ______________

Name of Cardholder (print) ___________________________________________________________________________________________________

Signature _____________________________________________________________________________________________________________________

Signature and Date (required)

Please sign and return this form to your sponsor organization if you wish to have courses you have taken from your

sponsor organization listed on an official Excelsior College transcript.

Signature: ______________________________________________________________________________

Date: ___________________________

Full signature required. Do not print.

Please forward this form to your sponsor organization contact person listed in Part 1.

Transcript Request (optional)

The Excelsior College NCCRS transcript service fee entitles you to receive one student copy of your transcript. If you

wish to have an official or additional student copy of your Excelsior College transcript, please complete the request

below and include the appropriate fee with your NCCRS application.

The current transcript fee is $12. If you require that the additional transcript be sent within 3 business days from

the date your NCCRS transcript is prepared, you will also need to pay the Transcript Rush fee for a total of $42.

Which transcript shall we send?

student copy

official copy

Are you requesting Transcript Rush service?

(additional $30 required, making a total of $42)

Yes

Authorization for release of transcript

Signature (required) _______________________________________________________

Date ____________________

Full signature required to release transcript. Do not print.

Send transcript to (print complete mailing address):

_______________________________________________________________________________________________________________

Excelsior College does not discriminate on the basis of age, color, religion, creed, disability, marital status, veteran status, national origin, race, gender, or sexual orientation in the edu-

cational programs and activities which it operates. Portions of this publication can be made available in a variety of formats upon request. Inquiries should be directed to the College’s

Affirmative Action Officer, Excelsior College, 7 Columbia Circle, Albany, NY 12203-5159.

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