Massage Transcript – Fill Out and Use This PDF

ordering an official transcript and/or diploma in person

Official Transcript/Diplomas can be ordered in person by going into your local Cortiva Institute Campus and submitting a completed Official Transcript Request Form. If a Transcript Request Form is submitted to a campus other than the campus you attended, we will forward your request to the campus you attended to be processed.

ORDERING AN OFFICIAL TRANSCRIPT AND OR DIPLOMA BY MAIL, FAX OR EMAIL

Official Transcripts can be ordered by mail, fax or email by sending in a completed Official Transcript Request Form to the campus you attended. Campus information is listed below. For email submission, please email transcript requests to

SEGTranscriptRequest@steinerleisure.com

NOTE: Student academic records are classified as confidential and may be released only with th student's authorization, in accordance with the Family Educational Rights and Privacy Act of 1974. Unsigned requests will not be processed.

*It can take up to 10 business days to prepare and send an official Transcript/Diploma.

charge for transcript

There is a $5.00 charge per Transcript and/or Diploma that is requested. Cash, Check or Credit Cards (excludes American Express) are acceptable forms of payment. Note: There is no charge for transcripts being sent to FSMTB (Mblex).

*Express Mail, Certified Mail, etc. is available upon request. Any additional costs for the services will be charged to the student/graduate.

CAMPUS location information

CortivaInstitute-ArlingtonCampus808WInterstate20#100,Arlington,Texas 76017(682)999-3150Fax(682)999-3132 Cortiva Institute - Aurora Campus 14107 E. Exposition Avenue, Aurora, Colorado 80012 (303) 366-4325 Fax (303) 366-5515 Cortiva Institute - Baltimore Campus 517 Progress Drive, Suite A-L, Linthicum, Maryland 21090  (410) 636-7929  Fax (410) 636-7857 Cortiva Institute - Chicago Campus17 North State St., Suite 500, Chicago, Illinois 60602(312) 253-3313Fax (312) 753-7901 Cortiva Institute - Crystal Lake Campus241 Commerce Drive, Crystal Lake, Illinois 66014 (815) 404-2700 Fax (312) 753-7901 Cortiva Institute - Dallas Campus1055 S. Sherman Street, Suite 100, Richardson, Texas 75081(972) 231-4590Fax (972) 231-4875 Cortiva Institute - Federal Way Campus2030 South 314th Street, Federal Way, Washington 98003 (253) 237-5300 Fax (253) 237-5358 Cortiva Institute - Groton Campus 1154 Poquonnock Road, Groton, Connecticut 06340  (860) 446-2299  Fax (860) 446-9410

Cortiva Institute - Hoboken Campus 2 Hudson Place, 2nd Floor, Hoboken, New Jersey 07030 (201) 215-6440 Fax (201) 215-6363 Cortiva Institute - Houston Campus13163 Northwest Freeway, Suite A, Houston, Texas 77040(713) 425-1585Fax (713) 690-1727 Cortiva Institute - Joliet Campus3033 W Jefferson St., Ste. 105, Joliet, Illinois 60435 (815) 272-9610 Fax (312) 753-7901

Cortiva Institute - King of Prussia Campus211 South Gulph Road, King of Prussia, Pennsylvania 19406 (484) 690-1400 Fax (610) 666-9061 Cortiva Institute - Las Vegas Campus 2381 E. Windmill Lane, Suite 14, Las Vegas, Nevada 89123  (702) 456-4325  Fax (702) 456-9910 Cortiva Institute - Miami Campus 7325 N.W. 12th Street, Suite #201, Miami, Florida 33126  (305) 597-9599  Fax (305) 597-9110

Cortiva Institute - Newington Campus 75 Kitts Lane, Newington, Connecticut 06111  (860) 667-1886  Fax (860) 667-2175 Cortiva Institute - Orem Campus 143 North State Street, Orem, Utah 84057  (801) 796-0300  Fax (801) 796-0309

Cortiva Institute - Orlando Campus 2600 Lake Lucien Drive, Suite #140, Maitland, Florida 32751  (407) 261-0319  Fax (407) 261-0342 Cortiva Institute - Phoenix Campus 10000 N. 31st Avenue, Suite D-100, Phoenix, Arizona 85051  (602) 331-4325  Fax (602) 331-4120 Cortiva Institute - Pompano Campus 2001 W. Sample Road, Ste #100, Pompano Beach, Florida 33064  (954) 975-6400  Fax (954) 975-9633 Cortiva Institute - Salt Lake City Campus25 South 300 East, Salt Lake City, UT 84111 (801) 521-3330 Fax (801) 521-3339

Cortiva Institute - Scottsdale Campus8010 E. McDowell Rd., Ste. 214, Scottsdale, Arizona 85257(480) 945-9461Fax (480) 425-8247 Cortiva Institute - Seattle Campus425 Pontius Avenue North, Seattle, Washington 98109 (206) 204-3175 Fax (206) 282-9183 Cortiva Institute - Tampa/St. Pete Campus2370 34th Street North, St. Petersburg, Florida 33713  (727) 865-4940  Fax ( 727) 545-0053 Cortiva Institute - Tempe Campus 1409 W. Southern Avenue, Suite 6, Tempe, Arizona 85282  (480) 983-2222  Fax (480)784-9477 Cortiva Institute - Tucson Campus6390 East Broadway, Tucson, Arizona 85710(520) 407-5160Fax (520) 407-5159

Cortiva Institute - Wall Campus1985 Highway 34, Wall Township, New Jersey 07719 (732) 359-1600 Fax (732) 282-1108

Cortiva Institute - Westminster Campus 8991 Harlan street, Suite B, Westminster, Colorado 80031  (303) 426-5621  Fax (303) 426-6611 Cortiva Institute - Westport Campus 25 Sylvan Road South, Westport, Connecticut 06880  (203) 221-7325  Fax (203) 221-0144 Cortiva Institute - York Campus 170 Red Rock Road, York Pennsylvania 17406  (717) 268-1881  Fax (717) 268-1991

LEGACY CAMPUS LOCATIONS

Brenneke School of Massage & Brian Utting School of Massage  Records are located at our Seattle Campus Location

Cortiva Institute - Boston Campus (Muscular Therapy Institute) & Cortiva Institute - Charlottesville Campus (Virginia School of Massage Therapy)

Please send requests to SEGTranscriptRequest@steinered.com  Records are located at our SLC Corporate Office Desert Institute of Healing Arts (DIHA)  Records are located at our Tucson Campus Location

Florida College of Natural Health - Sarasota Campus  Records are located at our Pompano Campus Location Pennsylvania School of Muscle Therapy (PSMT)  Records located at our King of Prussia Campus Location Phoenix Therapeutic Massage College  Records located at our Scottsdale Campus Location

Somerset School of Massage  Records located at our Wall Campus Location

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Student Name: _________________________________________________________________ Date: ___________________

Student Name while attending school: ______________________________________________________________________

Date of Birth: ______________ Class Number: ______________ Start Date: ______________ Grad Date: ______________

Student Address: _______________________________________________________________________________________

City: ________________________________________ State: ________ Zip: ___________ Phone: ______________________

Student Signature: ______________________________________________________________________________________

MAIL DOCUMENTS TO:

Name: _______________________________________________________________________________________________

Address: _____________________________________________________________________________________________

City: ________________________________________ State: ________ Zip: ___________ Phone: _____________________

ADDITIONAL INSTRUCTIONS/DOCUMENTS NEEDED:

Additional comments you need us to know about your request:

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

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CLEAR FORM

m Mastercard m Visa m Discover

PRINT FORM

Acct# _____________________________________________

Signature: _________________________________________

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