Transcript Request From Fairmont Form – Fill Out and Use This PDF

FAIRMONT STATE UNIVERSITY

TRANSCRIPT REQUEST FORM

We do not charge for normal processing of transcripts (2-5 business days). A special $9.00 rush charge will be assessed to orders that require 24 hour processing. Fill out one request for each separate mailing address. Transcripts will be processed in the order they are received. We cannot accept responsibility for delivery of transcripts once they leave our office. Requests must be made in writing. Requests from students who have financial holds on a student account will not be processed. If you check the RUSH box below, payment must accompany your request. Only 3 transcripts can be ordered at one time. We DO NOT fax or email transcripts.

Mailing Address: Fairmont State University, ATTN: Enrollment Services, 1201 Locust Ave, Turley Center Fairmont, WV 26554

Fax: (304) 367-4789; Email: enrollmentservices@fairmontstate.edu

REQUESTED INFORMATION

* All information marked with an asterisk (*) is required.

*SS# OR Student ID#: __________________________________ *Date of Birth: ____________________________________

*Last Name: _______________________________ * First Name: ________________________________ MI: ____________

Former Name(s): _____________________, _____________________, _____________________, ____________________

Current Mailing Address: ________________________________________________________________________________

City: __________________________________ State: __________________ Zip Code: ______________ - _________

*Telephone Number (____) __________ - __________ Email Address: ___________________________________________

*Are you a Fairmont State graduate? Yes No *Are you currently enrolled at Fairmont State? Yes No *If you are not currently enrolled at Fairmont State, enter the last year you attended: _________________________

*Select the following options: (Failure to check the correct space will result in a processing delay or additional charges.)

Hold transcript for end of current term grade processing	I will pick up on ___________________
Hold transcript for recent degree	Send transcript immediately
	RUSH (Payment MUST accompany request.)

I give _____________________________, ___________________________, permission to pick up my requests.

(Name)	(Relationship)
_______ Number of copies requested. (Please complete separate requests for different addresses.)
Mail Transcript(s) to:	___________________________________________________________ Institution
	___________________________________________________________ Name/Title
	___________________________________________________________ Address

___________________________________________________________ City/State/Zip

Please include CE courses.

Student’s Original Signature (required): ____________________________________________Date: ___________________

AUTHORIZATION TO CHARGE CREDIT CARD

Name on Card	Daytime Phone Number		Amount
	( )	-	$ 9.00
Address	Card #		Expiration Date
City, State, Zip	Signature		Date

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