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STI TRANSCRIPT REQUEST FORM

Fill out this form on-line

Send in check, money order for $2.00 per transcript or

Print out the form

Sign the form

Mail or fax the form to the address or FAX number on the bottom of the form

Include check, money order for $2.00 per transcript

NOTE: We will not process transcript requests submitted until payment is received.

First Name: Middle Initial: Last Name: Maiden Name, if attended under:
Street Address:
City, State, Zip:
E-Mail:		Phone No.:
Name of Program:
Are you currently enrolled? Yes No		Full-Time Student Part-Time Student
Dates of attendance OR Year of Graduation:
No. of Official Transcripts No. of Unofficial Transcripts No. of Official Transcripts issued to Student in Sealed Envelope

Students who have a completed Directed Study (Independent Study) or Field Study (Non-Traditional Study) and have a final description on file in the School's Office, please indicate whether you wish it to accompany your transcript.

Yes No

I hereby authorize the release of my transcript(s) to the address listed below.

Signature ___________________________________ Date______________

Mail Transcript(s) To:

Please fill out separate request forms if you wish to send transcripts to multiple addresses - (cost is $2.00 each)