Updated: 1/14/2015
FAIRMONT STATE UNIVERSITY
TRANSCRIPT REQUEST FORM
We do not charge for normal processing of transcripts (2-5 business days). A special $9.00 rush charge will be assessed to orders that require
24 hour processing. Fill out one request for each separate mailing address. Transcripts will be processed in the order they are received. We
cannot accept responsibility for delivery of transcripts once they leave our office. Requests must be made in writing. Requests from students
who have financial holds on a student account will not be processed. If you check the RUSH box below, payment must accompany your
request. Only 3 transcripts can be ordered at one time. We DO NOT fax or email transcripts.
Mailing Address: Fairmont State University, ATTN: Enrollment Services, 1201 Locust Ave, Turley Center Fairmont, WV 26554
Fax: (304) 367-4789; Email: enrollmentservices@fairmontstate.edu
* All information marked with an asterisk (*) is required.
*SS# OR Student ID#: __________________________________ *Date of Birth: ____________________________________
*Last Name: _______________________________ * First Name: ________________________________ MI: ____________
Former Name(s): _____________________, _____________________, _____________________, ____________________
Current Mailing Address: ________________________________________________________________________________
City: __________________________________ State: __________________ Zip Code: ______________ - _________
*Telephone Number (____) __________ - __________ Email Address: ___________________________________________
*Are you a Fairmont State graduate? Yes No *Are you currently enrolled at Fairmont State? Yes No
*If you are not currently enrolled at Fairmont State, enter the last year you attended: _________________________
*Select the following options:
(Failure to check the correct space will result in a processing delay or additional charges.)
Hold transcript for end of current term grade processing I will pick up on ___________________
Hold transcript for recent degree Send transcript immediately
RUSH (Payment MUST accompany request.)
I give _____________________________, ___________________________, permission to pick up my requests.
(Name) (Relationship)
_______ Number of copies requested.
(Please complete separate requests for different addresses.)
Mail Transcript(s) to: ___________________________________________________________ Institution
___________________________________________________________ Name/Title
___________________________________________________________ Address
___________________________________________________________ City/State/Zip
Please include CE courses.
Student’s Original Signature (required): ____________________________________________Date: ___________________
REQUESTED INFORMATION
AUTHORIZATION TO CHARGE CREDIT CARD
Name on Card Daytime Phone Number
( ) -
Amount
$ 9.00
Address Card # Expiration Date
City, State, Zip Signature Date
click to sign
signature
click to edit
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