Hudson Valley Transcript Request Form – Fill Out and Use This PDF

TRANSCRIPT REQUEST FORM

80 Vandenburgh Ave, Troy, NY 12180 (518) 629-4574 www.hvcc.edu

Submission: Submit this form to the Registrar’s Offi e in-person with picture ID, by mail to the address above or via fax at (518) 629-8094. Transcripts can also be printed and provided to a student in-person during regular business hours (photo ID is required). By federal law, e-mailed requests cannot be considered as consent for release of transcript information.

Web requests: Transcripts may be requested online via your HVCC WIReD account. Would you like your username and password mailed to you so you can access WIReD?  Yes  No (Please note your username and password must be mailed to the permanent address on file at the college.)

Processing: All requests are processed within 3 to 5 business days. Requests received via fax will be processed with those received by mail. Transcripts cannot be released without student signature. Any incomplete requests or those that cannot be processed due to outstanding financial obligations with the college will be returned to the student at the address provided below.

Fees: No fee is charged for transcripts sent via U.S. mail. There is a $10 fee for the Registrar’s Offi e to se d a u offi ial tra				s ript ia fa	see fa
pa e t i for atio	elo .
Name: _______________________________________________			HVCC ID# or SS#______________________________
Any previous names: ____________________________________			Date of Birth: _________________________________
Permanent Address: _____________________________________			Is this a change of name* or address?	 Yes	 No
			Name changes must be accompanied by a social security card. Your
______________________________________________________			name on file with the College must match your name as filed with
			the Social Security Administration Those not eligible for a social
Phone: (________) _____________________________________			security number must provide other legal documentation (i.e. ITIN
Did you attend prior to 1971?		 Yes  No	letter or court documentation).

Please send my Hudson Valley Community College transcript to the following address(es):

Request #1: ______________________________________	Request #2: ______________________________________
Office (if different than Admissions)	Office (if different than Admissions)
______________________________________	______________________________________
Name of College or Business	Name of College or Business
______________________________________	______________________________________
Street Address	Street Address
______________________________________	______________________________________
City, State, Zip	City, State, Zip
______________________________________	______________________________________
Fax Number (if unofficial transcript is to be faxed)	Fax Number (if unofficial transcript is to be faxed)

Transcript(s) will be sent immediately unless otherwise indicated below:

send transcript after degree/certificate is posted: expected completion date ____________________

send transcript after final grades are processed for the ____________________ semester

send transcript after revision of __________________________________________________________________________

STUDENT SIGNATURE _________________________________________________

Date ____________________

Transcripts cannot be released without student signature.

Office use only: Amount paid: $_______________	Receipt #: _______________	Date sent _______________
Cashier initials _______________	Payment date _______________	Registrar Initials _______________

Fax Payment Information: The fee to send an unofficial transcript via fax is $10 per transcript.

I have enclosed a check or money order in the amount of $_______________ payable to Hudson Valley Community College.

Please enclose the original check or money order. Copies of checks or money orders will not be accepted.

I authorize Hudson Valley Community College to charge my credit card in the amount of $_______________.

Card type (debit cards not accepted):  MasterCard  VISA

Card #: __________________________________________ Security Code ___________ Expiration Date _______________

Cardholder Signature __________________________________________________________________________________

Revised May 2014