Are you looking for a way to honor the legacy of Civil Rights activist and NAACP leader Medgar Evers? If so, you are in luck. The Medgar Evers Request Form gives individuals an opportunity to do that very thing by providing support to organizations that share his vision and passion. This form is available through the Medgar Evers Institute, which was established as part of three-year campaign dedicated to preserving and uplifting Mr. Evers' memory, mission, and legacy. Accessing and submitting this request form is easy - simply visit our website today and let us know how you’d like to become involved!
| Question | Answer |
|---|---|
| Form Name | Medgar Evers Request Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | evers transcript, medgar evers college transcript request, medgar evers college request transcript, medgar evers college registrar |
1637 Bedford Avenue – Room 301 |
OFFICE OF THE REGISTRAR 718.270.6040 |
Brooklyn, New York 11225 |
http://www.mec.cuny.edu/registrar/registrar_home_trans.asp |
TRANSCRIPT REQUEST FORM
A fee of $7.00 is required for each transcript except those transcripts sent to any unit of the City University of New York (C.U.N.Y.). Please submit only money order payable to Medgar Evers College.
Name on Record: ________________________________________________________________
LastFirstM.I.
Present name (if different):_________________________________________________________
LastFirstM.I.
Social Security Number: ___________________ Date of Birth: ________________________
Present Address: ________________________________________________________________
________________________________________________________________
________________________________________________________________
Day Phone #: ___________________ |
Email Address: ______________________________ |
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Please check the appropriate answer: |
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Undergraduate: _______ |
Graduate_________ |
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Matriculated: _________ |
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Graduated from Medgar Evers College? ______Yes |
______No |
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If yes, Degree and Date: _________________________________________________ |
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Currently in Attendance: _____________Yes |
__________No |
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Dates of Attendance: _____________________________ to ______________________________
Name and Address of Recipient: ____________________________________________________
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____________________________________________________
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Student’s Signature |
Date |
______________________________________ |
____________________ |
Authorizing Issuance of Transcript |
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Revised 1/9/12 NW |
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