Ocial Transcript Request
FOR THE STUDENT TO COMPLETE
Please complete the information below, and then give this form to your high school counselor to complete immediately.
Personal information
Legal Name
Last First Middle
Current Mailing Address City County/Province State (or country) Zip
Social Security Number __________________
*See enclosed disclosure and consent statement.
Name of High School
Address of High School City County/Province State (or country) Zip
As soon as we receive your completed application and ocial transcript,
we can complete your application and get you an admission decision. Thank you!
FOR THE SCHOOL OFFICIAL TO COMPLETE
We appreciate your prompt assistance in forwarding this student’s ocial transcript. Thank you!
Counselor information
Counselor Name
Last First Title
Counselor Signature Date
Counselor or Ocial’s E-mail address Phone
Please FAX this completed form and ocial high school transcript to 541.962.3418.
Or mail to:
Number of pages:
FAX number of School:
OFFICE OF ADMISSIONS
Eastern Oregon University
One University Blvd.
La Grande, OR 97850
* Social Security Number Disclosure and Consent Statement As an eligible educational institution, EOU must receive your correct social security number (SSN) to file certain returns with the IRS and to furnish
a statement to you. The returns EOU must file contain information about qualified tuition and related expenses. Privacy Act Notice—Section 6109 of the Internal Revenue Code requires you to give your correct
SSN to persons who must file information returns with the IRS to report certain information. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. For more
information please refer to IRS code 6050S. You will be issued a student ID number for your academic record at Eastern.
Revised: 11/20/2018
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