Transcript Request Form - Shawnee State University

Transcript Request Form
There is no cost for an official Shawnee State University transcript. All financial obligations to the
university must be cleared before transcripts will be released.
Indicate which transcript(s) you are requesting:
Number of copies _______
Please TYPE or PRINT legibly in the spaces below. If this form is not filled out completely, delays may result.
Last Name________________________________________ First Name__________________________________ MI _______
Other names used _________________________________________________ Email Address: ____________________________________
Student ID Number (if unknown, use SSN) ________________________________________________
Current Address _________________________________________________________________________________
City_______________________________ State__________ Zip __________________ Contact Number (______) _______________
Check this box if you would like the university to update your mailing address with the above information.
Student signature for release of transcript__________________________________________________Date_______________
Recipient Information:
Shawnee State University does not fax transcripts. Please choose only one option below.
In-person pick up. I hereby authorize _____________________________________to pick up this transcript on my behalf.
Please mail to address below (Complete a separate request form for each recipient. You are responsible for providing
the recipients correct name and address.)
Address 1:
Address 2:
Zip: ___________ Country: ___________________
Other actions: (Check all that apply)
I am currently enrolled. Please hold transcript until my grades for the following term are available:
Please hold transcript until my degree statement has been added. (recent graduates only)
Express Mail Payment Information
*US Express Mail: $22.95 fee / International Express Mail: $44.00 fee.
Only complete this section if you want to express mail your transcript.
Check or Money Order (enclosed)
Credit Card
Credit Card Number ____________________________________________________
Exp. Date __________________ 3-digit security code (located on back of the card) ______________________
Name of cardholder (as it appears on the card) _________________________________________________________
Cardholder’s Mailing Address Street_____________________________________ City_________________ State____ Zip ______
Signature of cardholder (if different than student) ____________________________________________________________
If Faxing: 740.351.3435
Attn: Student Business Center
If Emailing: [email protected]
If Mailing: Shawnee State University
Attn: Student Business Center
940 Second Street
Portsmouth, OH 45662