Please print clearly.
You must complete all information requested.
▪ Transcripts will not be released with any existing hold(s) on
record or until all accounts are paid in full.
▪ Fees are subject to change without notice.
▪ Student is responsible for providing a correct mailing
address below. Any address correction charges incurred by
the university will be charged back to the student.
▪ All bulk transcripts will only be mailed to one address. Each
transcript will be enclosed in a separate envelope with no
address indicated on it. All transcripts will be placed in one
envelope.
▪ The transcript is the student’s official and complete record of
all courses taken at Nova Southeastern University, regard-
less of number of degrees or programs attempted or
conferred. Partial records will not be released.
▪ NSU does not send transcripts electronically.
▪ Submit this completed form to the above address via postal
mail or fax.
Print clearly.
____________________________ __________________________
NSU ID Telephone
________________________________________________________
Present Name
_______________________________________________________
Name used at Nova Southeastern University
________________________________________________________
Address
________________________________________________________
City State ZIP
________________________________________________________
Email Address
Select one of the below:
Mail Transcripts to:
______________________________________________
Name
_______________________________________________
Address
________________________________________________
City State ZIP
Hold transcript for pick up at One-Stop Shop Horvitz.
Hold transcript for pick up at One-Stop Shop Terry.
_____ Email me when ready at ________________________
Email Address
_____ Call me when ready at (_______)__________________
Telephone Number
Bulk Rate Transcript Request
Social Security Number to be printed on the transcript
Print a masked SSN (ex. xxx-xx-1234)
Print full SSN
Special Instructions
Hold for degree conferral__________________________
Degree Anticipated Conferral Date
Hold for grade __________________________________
Course
Number of Transcripts Requested ______________________
# of Transcripts Charge
11 to 20 $110
21 to 40 $170
41 to 60 $200
61 to 100 $250
Method of Payment
Cash (only accepted at the One-Stop Shop)
Credit Card Check or money order payable to NSU
I hereby authorize a charge to be made to my credit card
VISA MasterCard American Express
________________________________________________________
Account Number
___________________________ ____________________________
Expiration Date Amount
________________________________________________________
Check/Money Order Number
_______________________________________________________
Signature* (required) Date
*Your signature authorizes the release of transcripts and any charges to your
credit card.
FOR OFFICE USE ONLY
Transcript fee 2021
Amount due $___________ Amount remitted $_________
Amount rec. $___________ By:_______________________
Credit Bal./ref. $______________________________________
Date issued ________________ By: ______________________
Hold reason _________________________________________
REV. 3/2019
DATE OF REQUEST ______ /______ /______
