Official Transcript Request Form
MAIL REQUEST TO: Sacramento State, Bursar's Office, 6000 J Street, Sacramento, CA 95819-6052
OR SUBMIT TO DROP BOX: In Front of Lassen Hall 1001 * DO NOT LEAVE CASH *
Official Transcript Fees
(7-business day processing, not including mail time)
$8
.00 per transcript
Your request will be returned to you and not processed if:
• There is a hold on your record • Full payment is not enclosed • Writing is illegible • Form is incomplete
STUDENT INFORMATION (PLEASE PRINT IN BLUE OR BLACK INK)
Name_____________________________________________________ Student ID #/SSN__________________________________________
Last First MI
Addre
ss_____________________________________________________________Former Name(s)__________________________________
Cit
y______________________________________State________________Zip_____________Email_________________________________
Phone
_____________________________Alt Phone __________________________Date of Birth___________________________________
Month Day Year
Are you currently enrolled? (Circle One) Yes No
Last Semester/Year of attendance at Sac State: _______________________________Term of Graduation: _____________________________
REASON FOR TRANSCRIPT REQUEST (Please check all that apply):
Grad School / Professional School
Please check all that apply:
TRANSCRIPT FEES ARE NON-REFUNDABLE):
Hold for current grades_____________(Semester/Year)
______ Official Transcripts at $8.00 each =_______
Hold for degree posting_____________(Semester/Year)
NOT AVAILABLE Rush order for an additional $15.00 fee
Hold for grade change from ____to_____
Course/Year___________
NOT AVAILABLE______ set of All Records at $15.00 each
Total fees included:$________
Hold for additional credit from___________________
Other special instructions _________________________
Pl
ease mail transcript(s) to the following address(s):
Please print additional addresses on a separate sheet of paper and attach to this form.
□ Include form with transcript □ Include form with transcript
____ # of Copies to: ____ # of Copies to
:
OFFICE USE ONLY: Holds Cleared __________ Sac State Requests ________ $________ A/R Requests _____ $ _____ Rush Service $ ______ Grand Total $________
Rev 04/14 Check #/Amt _______ / _______ Rcd Date/Initials _______ / ______ Date Verified/Initials _______/______Date Sent/Initials ________/ _______
STUDENT SIGNATURE (REQUIRED) ___________________________________________ DATE_______________
