Transcript Request Form

This form is for fax or mail use only. Complete this form online then print for faxing or mailing with payment. For in-person requests there is a request form available in the Office of the Registrar. All valid transcript requests received by the Office of the Registrar are processed and charged. As a result, if you are trying to submit only one request to be processed, please do not fax repeated times . Fax completed form to (317) 278-2240. Mail form to IUPUI Office of the Registrar Campus Center, Suite 250 - 420 University Boulevard Indianapolis, Indiana 46202-5144

Student Information

Last Name: First Name: Middle:

Name used while attending (if different):

Ten Digit University ID:

Email:

and/or

Daytime Phone#:

Last 4digits of SSN:

Date of Birth (mm/dd/yyyy):

Years attended To (yyyy): From: :

Street Address:

City: State: Zip: Country:

Processing Request Unless specified otherwise, we will immediately issue a complete, Official Indiana University Transcript including all completed coursework.

Exceptions: Graduate course work only Law only Dentistry only Medical Students (click here)

Hold for current semester grades

Hold for grade change in - course #: (i.e. math-a 111) Semester: Year(yyyy):

Hold for degree - Degree (i.e. BA/BS): Date expected(mm/yyyy):

Mail Transcript To: (complete only if transcript(s) to be mailed to location other than home address)

Name:

Street Address:

City: State: Zip: Country:

Signature and Printing Instructions - This form must be completed, printed, signed and sent with payment to the Registrar's Office by fax or mail.

Student Signature Date(mm/dd/yyyy):

Optional Express Delivery I request domestic (within United States) express delivery at a cost of $35.00US

I request international express delivery at a cost of $55.00US

I authorize express delivery charges including a $10.00US processing fee to be applied to my federal express account.

Account #:

Payment Information - Use the Delivery Options and Fees grid to assist calculating charges (click here)

Number of mailed transcripts requested: X $15.00 + (Optional Express Delivery fees (if any)) = Total: $

I want to pay by Credit Card: Visa Master Card Discover Card American Express JCB Card

Card #: Expiration date(mm/yyyy):

My check is enclosed and made payable to IUPUI.