BLACKFEET COMMUNITY COLLEGEOFFICE OF THE REGISTRAR
REQUEST FOR TRANSCRIPT
STUDENT NAME:_________________________________________ STUDENT ID:_______________ DOB:_______________
Student Enrollment Information:
Currently Enrolled Former Last Semester attended:_____________________________________(Semester/Year)
Transcript(s) to be prepared:
Now, and I will pick up on:________________________________________ at:_____________________________AM/PM
After FINAL or MID-TERM grades are recorded & Please MAIL (See address below)
After degree is posted & Please MAIL (See address below)
MAIL TO:____________________________________________________________________________________________
Location/Attn of: Address ST ZIP
STUDENT SIGNATURE:___________________________________________ DATE:________________________
Number of Official Transcripts Requested:_____ x $5.00 = $__________ Copies from file __________ x $1.00 = $________________
Number of Unofficial Transcripts Requested:____ x $2.00 = $_________ _________________________________________________
(List what you are requesting from your student file)
Fax Charge: $10.00 X ____ = $__________ Fax to: (______)_______________ Attn whom:______________________________________
Office Use Only:
Amount received: $_______________ Initialed: ___________ Student Billing Clerk:___________
Date Printed:___________________ Date Picked Up:________________ By Whom:______________________________________
Date Mailed:___________________ Mailed by (initials):___________ Faxed Date: ___________________ Faxed by (initials):___________
TRANSCRIPT(S)/FILE REQUESTS MUST BE PAID IN FULL BEFORE THEY WILL BE PROCESSED.
White: Student File Yellow: Student
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