Academic Records Request Form
Transcripts, Enrollment Verifications, General Requests
University of North Texas Health Science Center
Office of the Registrar, SSC 240
3500 Camp Bowie Blvd.
Fort Worth, TX 76107-2699
(817) 735-2201 / Fax (817) 735-0448
registrar@unthsc.edu
A student’s transcript includes ONLY the academic record accumulated at the University of North Texas Health Science Center.
OFFICIAL copies of transcripts from other institutions CANNOT be furnished.
Questions regarding data collected may be directed to the Registrar. (HB 1922)
Student ID OR Social Security Number
Date of Birth
Program
Texas College of Osteopathic Medicine
Graduate School of Biomedical Sciences
School of Public Health
School of Health Professions (PA & DPT)
System College of Pharmacy
Last Name First Name Middle Name
Email Address
Daytime Telephone Number
Other Names Used While Enrolled at UNTHSC
Graduating Year
I would like to request:
Special Instructions:
Hold my transcript for final grades (please specify which course
or semester): ____________________________
Hold my transcript for the degree to be posted.
Include the attached document with the transcript.
Other: ________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Dean’s Letter / MSPE
(TCOM only)
Other Document:
______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Delivery Method:
I would like to pick up my documents in person.
(Please bring a photo ID to the front desk of Student
Affairs for document pick up.)
Mail to: _______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Fax to:
Attn:____________________________________
Fax Number: _____________________________
Email to:
________________________________________________
________________________________________________
I certify that I am the person whose name appears on the
name line of this form, and do hereby authorize release of my
academic records via the method listed above.
_______________________________________________ ____________________
Signature Date
Please allow 24-48 hours for processing. Enrollment verifications will not be processed until after the census date.
For Office Use Only
Revised 08/04/2017 Date request completed ________
click to sign
signature
click to edit
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