SUNY Orange
Records & Registration
115 South Street
Middletown, NY 10940
Tel: 845-341-4155
Fax: 845-342-8662
Are you currently enrolled at SUNY Orange ___Yes ___No
If not currently enrolled please indicate approx. date of last attendance _______________
WHEN DO YOU WANT YOUR TRANSCRIPT TO BE SENT: (Choose only one option per request)
NOW – Do not hold for grades or notation of degree
Hold for current semester grades. (Check one) ____ Fall ____ Spring ____ Summer 1 _____ Summer 2
_____ Community College in High School
Hold for notation of degree (Check one) _____Dec. Graduate _____ Aug. Graduate _____ May Grad
PRINT BELOW THE NAME AND/OR OFFICE AND ADDRESS WHERE YOU WANT THE TRANSCRIPT SENT
Number of Copies to be sent to the below address: ________ ( Calculate fee of $8.00 per copy)
*DO NOT WRITE BELOW THIS LINE - FOR OFFICE USE ONLY*
Bursar Fee Paid____________________
Initials ___________________________
Date _____________________________
Date Processed _________________
Initials_________________________
Notes:
Revised August 21, 2013
Student’s Current Address:
Student ID#: A ___ ___ ___ ___ ___ ___ ___ ___
(OR)
SSN ID#: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Checklist: Please be sure to include:
Sign the request
Requester is responsible for complete and accurate address
Please include $8.00 in the form of a check/MO or credit card information for a VISA,
Master Card, Discover & AMEX for each transcript requested. Please make the check/MO
payable to SUNY Orange
Your Telephone Number with your request
If applying in person be sure to have picture ID
Please be aware transcripts are processed in the order in which they are received and will
take approximately 7-10 business days.
If paying by credit card please include the following:
___VISA ___Master Card ___Discover ___AMEX
Name on Card:____________________________________________
Credit Card Number:________________________________________
Security Code Number:______________________________________
Expiration Date: ___________________________________________
*Billing Information (ONLY if different from above)
Street Address__________________________________
City/State/Zip____________________________________
Transcript Request Form
Print and complete form then mail or fax with
appropriate fee to Records & Registration
