Graduate School of Engineering & Management
Transcript Request Form
2950 Hobson Way
WPAFB, OH 45433-7765
ATTN: Registrar's Office
Telephone: Comm (937) 255-6234 DSN 785-6234
Fax: Comm (937) 255-2791 DSN 785-2791
Complete and return to the above address. If not filling out this form on-line, please make sure that you print legibly.
PRIVACY ACT STATEMENT:
The following information is provided as required by the Privacy Act of 1974 authorized by 10 USC 8012.
In order to process this application, we must ask for a Social Security Account Number if you are a US Citizen. Even though not required, it will help in expediting this
application; however, failure to provide the information will result in the designated agency not receiving transcripts as requested by the student.
Official Copy (Institute Use Only) (No Charge) Student Copy (No Charge)
1. Personal Information
First Name Last Name Middle Name/ Initial Maiden Name or Other Name(s)
SSN or Student ID # Daytime Phone Number Date Of Birth Email Address
2. Permanent Address
Address Address 2 City State Zip
3. Current Status
Are you currently enrolled? If no, please indicate approximate dates of attendance
Yes No Semester Year
Hold for Degree Posting?
Degree(s) Earned/Program Enrolled
Master of Science CertificatePhD
4. Mailed Transcript Information
Number of transcripts being mailed to the address below:
Name Address City State Zip
Note: Student is responsible for the correct address. Transcript(s) will be mailed to the address indicated above.
5. Faxed Transcript Information (Only complete if requesting a FAX transfer)
Number of transcript(s) to be FAXed to the number below.
Fax Number: Send Fax Attention:
6. Brief Student Comments
7. Signature and Date: Transcript request without signatures cannot be processed.
Student's Signature: Date: