Transcript Request Form Plaza College
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1Transcript Request Form
To request an official or unofficial transcript, please complete the form below by filling in all requested
information, print the form, then mail or submit to the Plaza College Registrar’s Office, 118-33 Queens Boulevard
Forest Hills, NY 11375.
Mail this form along with the money order for the correct amount.
Please be sure that you sign and date the Transcript Request Form, Plaza College will not release the
transcript without a signature. A transcript will not be issued if you have a hold on your account.
(Please Print Information)
Personal Information:
Last Name:
First Name:
M.I.:
Name while enrolled (if different from above):
Phone Number:
SS # :
Address (while in attendance):
Current Address:
Date of Attendance From:
To:
Course:
Graduated: Yes
No
Date of Graduation:
Email address where you can be reached:
Purpose of Transcript:
College
Employer
Personal
Other
If Other, Please Specify:
Transcript Information:
Associate Program
Bachelor Program
Number of Transcripts Requested:
Amount Enclosed:
Authorization: I hereby authorize Plaza College to release my school records. (Must have signature to process request)
Signature:
Date:
Send Official Transcript To: Enter the name and complete address below for Official Transcript.
If requesting an official transcript to be mailed to your home address, envelope will be stamped “official transcript”. Student must
deliver envelope to college/employer unopened or transcript is NOT valid. Do not open envelope.
Name:
Office:
Address:
City:
State:
Zip Code:
FOR OFFICE USE ONLY:
Financial Services Clearance:
Yes
No
Academic Clearance:
Yes
No
Transcript Mail Date:
Payment Received: ___________ Receipt#: ___________ Semester: ___________
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