Transcript Request Form

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Transcript Request Form
Name: _____________________________________
Student G#: ___________________
Date of Birth: __________________
Address: __________________________________
Former Name (if applicable):
__________________________________
_______________________________
Currently enrolled? __
Yes
Telephone #: _______________________________
If NO, year of last enrollment: _______
Number of Copies: _____
Send Transcript As Is
__
Send Transcript(s) to:
Hold for posting of current
__
semester grades
Recipient Name: ______________________________
__ Hold for graduation verification
Address: ____________________________________
__
Other:____________________
City, State ZIP: _____________________________
For Office Use Only:
______ Date Requested ____ Initials
______ Date Sent
____ Initials
Student Signature: __________________________________
Date: ___________
Completed forms may be returned in person to the Student Assistance Center in Allendale (150
Student Services) or at the Grand Rapids Pew Campus (115C DeVos), by fax to (616) 331-2000,
or by mail to the Registrar's Office, 150 Student Services, Allendale, MI 49401.

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