Transcript Request Form original

Malone College
Office of the Registrar
Transcript Request Form

Last Name: First Name: Middle Initial:
Maiden Name: SSN:
Address:
City: State: Zip:
Phone:


Date of Birth: Date of Last Attendance (mm/yy):
Graduation Year (if applicable):


Please send  ______ copy(s) of my Malone College Transcript to:

Name:
Attention:
Address:
City: State: Zip:


Do you need to have the transcripts in a sealed envelope/envelopes? (please check)

Yes
No

The signature of the student is required for the release of a transcript:

Signed: ________________________________________________________________________

Date: __________________________________________________________________________

Enclose payment according to the following fee schedule: (send check or provide credit card information)
  •     $5.00 per transcript
  •     $5.00 per transcript and an additional $5.00 for expedited, same day, or authorized faxing services
  •     $5.00 per transcript and an additional $20.00 for FedEx or similar next day service (11:00 am deadline)
credit card #:                                                                    exp date:                                                security #:
 
Mail this completed form to: (E-Mailed Forms Cannot be Accepted!)
Malone College
Office of the Registrar
515 25th Street NW
Canton, OH   44709
1.800.521.1146