Frm Transcript Request Goarmyed Page 2
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1
2Undergraduate Distance Learning Program
Transcript Request Form
Please process this request within one (1) week.
•
If any difficulties in processing are encountered, please contact the Liberty University Transcript
•
Processing Office at 434-592-3796 or the Admissions Office at 1-800-424-9595, Option 1.
An Official High School/College
Full Graduation Date
transcript contains the following:
Please send one (1) Official Academic
Grading Scales
Transcript & a copy of this form to:
Grade Point Average
Attn: DLP Transcript Office
Official School Seal
Distance Learning and Graduate Studies
Signature of School Official
Liberty University
Semester Grades by Course
1971 University Blvd.
Final Grades by Course
Lynchburg, VA 24502-2269
** Please include all test scores available.
Applicant Information
Name
Last
Maiden
Middle
First
Current Address
City
State
Zip code
/
/
-
-
(
)
-
________________________
Date of Birth
Social Security Number
Phone
Email
Student ID#: ___________________
(if known)
Student Consent
As an applicant to Liberty University’s Distance Learning and Graduate Studies, I authorize you to release my academic
records.
_____________________________________________________
______________________________________________
Signature
Date
College/University/High School Attended
Name of Institution
Campus
Street
City
State
Zip Code
Country
Phone
Office Fax (if known)
Dates Attended: (from)____________/_______ (to)____________/________ _______________________________
month
year
month
year
Degree awarded (if any)
(provide approximate dates if unsure)
Payment Information
(Students – Do Not Use. This is for Liberty Office Use Only)
Type of Card _________________
Credit Card #_______________________________________
Exp Date_____________
Sec. Code ________ Fee Amount $____________________________________
Signature
________________________________________________________________________________
FRM_Transcript_Request.pdf
4/25/2007
Page 2 of 2
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