Goshen College

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Personal information Student ID or SSN _______________________________________ Birth date ______ / ______ / _____ I am a current student Last date of attendance _________________ Last name _______________________________ First _______________________________ Middle _____________________
Name used while attending (if different) ________________________________ E-mail address ___________________________
Current address ___________________________________________________________________________
City __________________________ State/Prov. ___________________ ZIP _____________ Phone _______________________ Signature ______________________________________________________________________ date _____________________ For your protection, transcripts will not be released without a written signature Transcript request information Transcripts will not be provided for students with financial and other obligations to the College. The processing time for transcripts is
3-4 working days. Please allow additional time during peak processing periods such as beginning and ending terms. I will pick up ___ transcript(s) on _____________ (date) Mail ___ transcript(s) to me at the above address Mail ___ transcript(s) to the name(s) and address(es) below: Mail ________ transcript(s) to:
Name ____________________________________________
Address 1 __________________________________________
Address 2 __________________________________________
City _______________ State/Prov. _______ZIP __________ Mail _______________ transcript(s) to:
Name ____________________________________________
Address 1 __________________________________________
Address 2 __________________________________________
City _______________ State/Prov. _______ZIP __________ Please send: Undergraduate work only
Graduate work only
Both Undergraduate and Graduate work Hold for (optional): Hold for current term grades
Degree posting-date to be awarded __________________ Payment information Paid by: Cash Check MasterCard Visa Discover Credit card number _____________________________________ Expiration date __________________
Name on credit card ____________________________________ Three Digit Security Code _________
Number of transcripts requested ___________________________@$4.00 each = ____________________ Office use only Date issued _____________ by ________ Cash Check Credit Free 1700 S. Main St., Goshen, IN 46526/ Information: (574)535-7517 / Fax: (574)535-7660 Complete all information and sign your request. Goshen College Office of the Registrar Request for Official Transcript 0 $0.00

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