Transcript Request Regent University Va

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Ed.D. Cohort Programs
Transcript Request Form
As part of your application to Regent University, we are excited to offer
Office Use Only:
you the free service of requesting your transcripts on your behalf. Please
Banner #:_________________________________
follow the guidelines below in order to help us request your transcripts
Term: ___________________________________
for you. If you have any questions please feel free to contact the Transcript
Coordinators at (757) 352-4428 or by email at transcripts@regent.edu.
Request Date: ____________________________
________________________________________
CAS
SBL
GV
CA
PC
DIV
SOE
INSTRUCTIONS:
1) Print out this Transcript Request Form (one copy for each degree granting institution that you have attended)
2) Complete all sections of the form(s)
3) Sign the form(s) - your handwritten signature is required; electronic signatures cannot be accepted
4) Return the form(s) to Regent University through one of the following methods:
Option 1: Scan and E-mail the form(s) to .
Option 2: Fax the form(s) to 800-504-7618.
Option 3: Mail the form(s) to:
Regent University, Enrollment Support Service, Transcripts,
1000 Regent University Dr., Virginia Beach, VA 23464-9800
Option 4: Complete an electronic transcript request at
5) Regent will forward each form to the institution listed and pay for any required transcript fees on your behalf*
*Note: Regent University is not able to request a transcript(s) for any of the following: an institution that will not accept credit
card payment for transcripts; an applicant has a balance due at a previous college; a transcript is from a school not recognized
by the U.S. Dept of Education; a transcript is from a school that no longer exists; international transcripts; home school tran-
scripts; high school transcripts; or SAT/ACT/GED/LSAT/GRE/GMAT score reports.
APPLICANT INFORMATION
(You must have submitted an application and paid an application fee to take advantage of this service)
First Name: _________________________ Middle: ____________________ Last: _________________________________
Maiden Name: (List all previous names) _______________________________ E-mail: ________________________________
Street: __________________________________________ City: ______________ State: _________ Zip: ______________
Social Security Number or Student ID: ________________________ Date of Birth __________________________________
COLLEGE/UNIVERSITY ATTENDED
Name of Institution: ___________________________________________ Campus: ________________________________
Street: __________________________________________ City: ______________ State: _________ Zip: ______________
Phone: __________________________________________ Fax (if known); ______________________________________
Dates attended: (from) ___________ (mm/yy) to ____________ (mm/yy) Degree Awarded: ___________________________
STUDENT CONSENT
As an applicant to Regent University, I authorize the institution named above to release my academic records. Please send an
official copy of my academic records to Regent University by mail to the address above or by email to ess@regent.edu.
Student Signature: _______________________________________________________Date _________________________
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