New York College Of Podiatric Medicine

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NEW YORK COLLEGE OF PODIATRIC MEDICINE
th
53 East 124
Street · New York, NY 10035
Office of Records and Registration
(212) 410-8054
GRADUATE/FORMER STUDENT REQUEST FOR TRANSCRIPT
(CURRENT STUDENTS USE STUDENT TRANSCRIPT REQUEST FORM)
Print clearly, completing all sections. You
______________________________________________________
must sign and date this form. Make check
Name
or money order payable to NYCPM (see
______________________________________________________
fees below. Requests will be processed in
Address
______________________________________________________
the order received unless fee is paid for
City
State
Zip code
special handling. A confirmation copy of
this form will be sent to you.
Student ID #:___________ E-mail address: ___________________________________
Home
Other Phone
Phone:_______________________________ if applicable: _____________________________
Check items as appropriate:
Graduate
Former Student
Graduation Date: ________________ OR
Last date of attendance ____________________
mo./yr.
mo./yr.
Official transcript
Unofficial copy
ADDITIONAL INSRUCTIONS TO REGISTRAR:
_______ number of copies of transcript
Include Clinical Evaluation _____ number of copies of evaluation
Include Dean’s Letter
Special Handling (Overnight)
Hold for pickup**
-
Note: Graduates/former students must order National Board scores directly from the National Board/Chauncey Group.
**Official transcript for pickup is addressed to qualified recipient in sealed envelope with security stamp. Only unofficial transcripts
may be Faxed. Fee schedule: Graduate or former student Transcript $10.00 Add Clinical Evaluations – no additional charge; Special
Handling (e.g., Express Mail) $18.00 minimum.
Signature: _________________________________________ Date: _____________________
Print plainly the name, office and address of recipient to whom
transcript is to be sent. Use separate form for each addressee.
Official Use Only
Signature verified
Mailed on ____________
Original – recipient
st
1
copy – Registrar
nd
2
Copy - Student

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