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 : firstname.lastname@example.org (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.)
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
For Office Use Only
Date mailed ________________________________