EPI TRANSCRIPT REQUEST FORM
Fill out ONE form for EACH delivery address
EĂŵĞ͗Last First Middle
(Please Print) (Please Print) (Please Print)
Previous Name(s)
Student's ID Number or Last 4 digits of SSN
Current Address
City State Zip Email
I affirm that I am the above-named student. In compliance with FERPA, I hereby give my written consent and authorize Eastern Florida State College
to release my academic record as noted. I understand that my account at Eastern Florida State College must be in good standing in order for transcripts
to be processed.
Print this form and take to any campus cashier with payment or mail to the Office of the Registrar with check.
Office of the Registrar, 1519 Clearlake Road, Cocoa, FL 32922 for processing.
Student's Signature Date Daytime Phone
(Signature is required for processing) (Required)
I would like to order copies of my transcript. Transcript Request Type
EPI Coursework EPI and EFSC coursework
Standard Processing ($5 per transcript) (may take 5 to 10 working days)
Fed-Ex ($25 per each mailing address + transcript fee)
Request must be hand-carried to the Office of the Registrar 321-433-7284
After this semester's grades are posted
After degrees are posted
I have included/faxed an attachment
Pick-up in Office of the Registrar - Cocoa Campus only (photo ID is required)
Other
REQUEST FOR TRANSCRIPT CAN BE PROCESSED ONLY IF ALL INFORMATION IS COMPLETE AND LEGIBLE
Provide name and exact address of where transcript is to be mailed (use additional form if needed)
Mail to: Attention:
Address:
City State Zip Code:
Processed by:
Date:
Registrar Received Date
Re
vised 08/12
