Transcript Request Form - Suny Orange
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1SUNY Orange
Transcript Request Form
Records & Registration
115 South Street
Print and complete form then mail or fax with
Middletown, NY 10940
appropriate fee to Records & Registration
Tel: 845-341-4155
Fax: 845-342-8662
Student Name:
Date of Birth
Maiden (Former) Name:
Student’s Current Address:
Student ID#: A ___ ___ ___ ___ ___ ___ ___ ___
City / State / Zip
(OR)
SSN ID#: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Signature:
Date:
Telephone Number:
Are you currently enrolled at SUNY Orange ___Yes ___No
If not currently enrolled please indicate approx. date of last attendance _______________
WHEN DO YOU WANT YOUR TRANSCRIPT TO BE SENT:
(Choose only one option per request)
NOW – Do not hold for grades or notation of degree
Hold for current semester grades.
____ Fall
____ Spring
____ Summer 1 _____ Summer 2
(Check one)
_____ Community College in High School
Hold for notation of degree
_____Dec. Graduate
_____ Aug. Graduate
_____ May Grad
(Check one)
PRINT BELOW THE NAME AND/OR OFFICE AND ADDRESS WHERE YOU WANT THE TRANSCRIPT SENT
Number of Copies to be sent to the below address: ________
( Calculate fee of $8.00 per copy)
Transcript Addressed to:
Office/Department:
Street Address
If paying by credit card please include the following:
___VISA
___Master Card
___Discover
___AMEX
City / State / Zip
Name on Card:____________________________________________
Credit Card Number:________________________________________
Security Code Number:______________________________________
Checklist: Please be sure to include:
Expiration Date: ___________________________________________
Sign the request
Requester is responsible for complete and accurate address
Please include $8.00 in the form of a check/MO or credit card information for a VISA,
*Billing Information (ONLY if different from above)
Master Card, Discover & AMEX for each transcript requested. Please make the check/MO
payable to SUNY Orange
Street Address__________________________________
Your Telephone Number with your request
If applying in person be sure to have picture ID
Please be aware transcripts are processed in the order in which they are received and will
City/State/Zip____________________________________
take approximately 7-10 business days.
*DO NOT WRITE BELOW THIS LINE - FOR OFFICE USE ONLY*
Date Received:
Bursar Fee Paid____________________
Date Processed _________________
Initials ___________________________
Initials_________________________
Date _____________________________
Notes:
Revised August 21, 2013
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