Transcript Request Form

ADELPHI UNIVERSITY * ONE-STOP STUDENT SERVICES CENTER * ONE SOUTH AVENUE * GARDEN CITY, NY 11530 * 516-877-3300

Part 1 – Student Information

Name _______________________________________________ Prior Name(s) (if any) __________________________________ Date __________________

Last Name First Name

ID or Soc Sec No ______________________ Phone ___________________ Email_________________________ Signature ____________________________

Part 2 – Please Check ALL that Apply

*If requesting an Official Transcript, payment is required for processing. Make check or money order payable to Adelphi University.

Official Transcript ($10.00 each)

Quantity _______

Hold for Grades _______________

Semester

Attended Prior to Fall 1977

Attended through the NYSUT Program ___________

Year

Attended through the

Long Island High School (LHS) Program ___________

Year

Student Copy (no charge)

Hold for Degree Notation

________________

Degree Date

Part 3 – Transcript Information

Picking Up Transcript

*No Address needed Below*

Mail Transcript to Address Below

Address

*If mailing to multiple addresses, please use a separate form for each address.

____________________________________________________________________

An official transcript is one that bears the seal of the University

and an authorized signature. It can be sent directly from the

Registrar to another institution, agency, or individual at the

written request of the student, or it can be mailed or given

directly to the student in a sealed envelope. Transcripts can be

released to parents or a third party, as long as the student gives

them written authorization and proof of identity must be shown.

Registrar Use Only:

Date Processed ________________ Initials _________