AUGUSTANA COLLEGE TRANSCRIPT REQUEST
OFFICE OF THE REGISTRAR, AUGUSTANA COLLEGE
639 38TH STREET, ROCK ISLAND, IL 61201
PHONE: (309)794-7211, FAX: (309)794-7544
EMAIL : michelleramirez@augustana.edu (email must include pdf of form with handwritten signature)
INCOMPLETE FORMS WILL NOT BE PROCESSED Today's Date: _____________________________________
Currently enrolled at Augustana: YES _____ NO ______
or est. date last attended/ graduation date (mm/yy): ______________________________
RESTRICTIONS MUST BE CLEARED BEFORE REQUESTS WILL BE PROCESSED
TOTAL TRANSCRIPTS REQUESTED ______ _
STUDENT I.D. # (if known) ________________________________ LAST FOUR DIGITS OF SS# ______________
BIRTH DATE _________/_______/________ EMAIL ADDRESS ___________________________________
CURRENT CONTACT TELEPHONE # _____________________
STUDENT'S NAME AS IT APPEARS WITH AUGUSTANA RECORDS (PLEASE PRINT):
____________________________________________________________________________________________________________
LAST FIRST MIDDLE (MAIDEN or FORMER)
______________________________________________________________________________________________________ _
HOME ADDRESS/OR SCHOOL ADDRESS
____________________________________________________________________________________________________________
CITY STATE ZIP CODE
HANDWRITTEN SIGNATURE: ____________________________________________________________________________________
PLEASE SEND MY TRANSCRIPT AT A COST OF $12.00 EACH* ($20 for rush or faxed orders)
(Include department or name of person in address, etc.)
Recipient:
__________________________________________________
__________________________________________________
__________________________________________________
YOU ARE RESPONSIBLE FOR SUPPLYING THE CORRECT ADDRESS
If an address correction is requested, the requestor will be responsible for all fees for sending additional transcripts.
*Paper requests received by fax or mail are $12.00 per transcript with prepayment by check (Payable to: Augustana College) or cash or call the Office of
the Registrar 309-794-7211 to make credit card payment. Electronic requests are $8.00 per transcript and must be paid in advance by credit card*. In
order to receive a secure Alumni and Friends on-line login and submit an electronic request, alumni should contact the Advancement Office at 309-
794-7474. There is a $20 prepayment charge per transcript over five requests in a five day period or for rush and faxed orders. Please allow three to
five business days for regular processing and up to two-three weeks during peak processing times (after final grades, graduation and January-February).
Students who first were admitted to Augustana prior to 1991, please follow these steps to have your transcript processed:
1. Complete this request form and submit it by fax, mail, e-mail, or drop-off to The Office of the Registrar; and
2. Make pre-payment of $8.00 per transcript ($20.00 for rush and faxed requests) by cash, check or call the Office of the Registrar to make
credit card payment.
*Declined credit cards and unpaid transcript requests will be deleted within one week of receipt.
*International Transcript requests require payment by an US issued credit card or money order.
Please visit the Augustana website for the complete transcript policy: www.augustana.edu/academics/registrar
12/06/2019 MR
For Office Use Only
Fee ____________________________
Recorded __________________________________
Date mailed ________________________________
