Amberton University Transcript Request – Fill Out and Use

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Please give your full name and mailing address. Print legibly,

this label will be used for mailing. Fax this form to (972) 279-9773.

Please Check All That Are Appropriate:

___Mail ___Will Pick Up

___Hold Until Degree is Posted

___Hold Until Current Session Grades are Posted

Social Security No._________-_________-___________

Daytime Phone No._______________________________

Give Date of Last Attendance_______________________

SIGNATURE (Required)_____________________________________

*USE A SEPARATE FORM FOR EACH ADDRESSEE

PLEASE SEND _____ COPIES OF MY TRANSCRIPT TO

THE ADDRESS BELOW: (MAILING LABEL—PRINT CLEARLY)

PLEASE NOTE:

Transcripts will not be released unless the student is in good standing with the University and has satisfied all admission, financial, and other obligations. No transcript will be released if a student has a delinquent account or has defaulted on a promissory note. A $5.00 fee must accompany each request. Incomplete forms will be returned.

Date____________________________________

Last Name_______________________________

First Name_______________________________

Middle/Maiden Name______________________

TRANSCRIPT CANNOT BE SENT FOR THE FOLLOWING REASON:

____Student owes a BALANCE ON ACCOUNT.

____No transcript fee enclosed ($5.00 each).

____No signature.

____No record of attendance under name or

social security number provided.

Date Returned______________

FOR OFFICE USE ONLY

DEBT_______ NO DEBT_______

FEE PAID_______

DATE MAILED_______________