For Office Use Only
Date Paid ____________ Receipt # ____________ By __________________________
Date Transcript Processed _____________________ By __________________________ q Attachment Sent
OFFICIAL TRANSCRIPT REQUEST
Student Registration and Records Office
4240 Campus Drive Lima, OH 45804
I
(419) 995-8425
I
www.RhodesState.edu
Business Office
Rhodes State College
4240 Campus Drive
Lima, OH 45804
1. Check Service Desired: Transcripts are currently being processed once a week. It may take up to 5 business days to process.
q Standard Service ($5.00 per copy) Number of Official Copies: __________ Dollar Amount Enclosed: $ __________
q USPS Priority Mailing Fee: $__________
Add $24.70 for each transcript. ($5.00/transcript + $24.70/mailing = $29.70)
q Hold for current term grades q Hold for awarding of degree
Email completed form to
cashier@rhodesstate.edu
and then call the Business Office at (419) 995-8473 to make credit card payment or
mail completed form to address above. Payment must accompany all requests. Make checks payable to “Rhodes State College”.
2. Student Information
Full Name ________________________________________________________________________________________________________________
Former/Maiden Name(s) _____________________________________________________________________________________________
Student ID (R#) or SSN
______________________________________________________________________________________________________
Date of Birth
______________________________________________________________________________________________________________
Current Address
____________________________________________________________________________________________________________
City
_____________________________________________________
State
___________________________
Zip
__________________
Phone
__________________________
Dates of Attendance: From ______________________________ to
___________________
Did you graduate from Rhodes State College/Lima Technical College? q Yes q No
3. Select Mailing Option
Please, allow up to 2 weeks for receiving institution to process.
q Mail transcript(s) to address above. q Mail transcript(s) to address below.
Complete contact name/address if transcript is being sent to an address other than your own.
Attention
_________________________________________________________________________________________________________________
Company/School
__________________________________________________________________________________________________________
Address
___________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
City
_____________________________________________________
State
___________________________
Zip
__________________
4. Student Signature:
Transcripts are released in accordance with the Family Educational Rights and Privacy Act of 1974, as amended.
Student Signature
__________________________________________________________________________
Date
______________________
Please Note: No records will be released if there is an outstanding obligation to the institution.
