Transcript Request Form
Office of the Registrar
P. O. Box 4448, Clarksville, TN 37044
Phone: (931) 221-7150 ▪ Fax: (931) 221-6264 ▪ Email: registrar@apsu.edu
Transcripts are issued in accordance with the Federal “Family Education Rights and Privacy Act of 1974” and only sent to
a third party by written request from the student.
Please complete a request form for each address to which you want your transcript sent. After
completing this form, please print and sign. Fax, mail or email the signed request(s) to the above
number or address.
Last Name
First Name
Middle Name
Maiden Name
Current Street Address
Student ID
Date of Birth
City
State
Zip
Current Daytime Phone
Number of
First
Last Term/Year
Did you graduate?
Email Address
Transcripts
Term/Year
Enrolled
Needed _______
Enrolled
Yes
No
__________
_____________
Please process immediately
Hold for current term grades
Hold for degree statement
Yes
No
Yes
No
Yes
No
Signature to request transcripts
Date
Please allow 5-7
business days for
transcript service.
There is no charge.
X
(If you wish to pick up your transcript, please print “pick up” in the name section)
MAIL TO:
Name (Person)
Business or Institution
Street Address
City, State, Zip
Office Use Only
NO TRANSCRIPT WILL BE ISSUED IF ANY FINANCIAL
OBLIGATION TO THE UNIVERSITY EXISTS OR IF YOU HAVE NOT
Date Processed _______
Initials _______
COMPLETED THE ADMISSION PROCESS.
--revised 8/27/15