Transcript Request
PC-1144 6/2011.1
Submit this form in person or by mail or fax to: Registrar’s Office - DIF 114
Student & Administrative Services Center, Room 1020
Pennsylvania College of Technology
One College Avenue • Williamsport, PA 17701-5799
Fax: 570.321.5536
Penn College ID or Social Security number* _______________________________________________________________________
* The Registrar’s Office requires your Penn College ID or Social Security number for the purpose of verifying your identity with official educational records. If you do not
provide your Penn College ID or Social Security number, the College cannot guarantee the authenticity of your transcript. The College will not disclose Social Security
numbers to anyone outside of the College without an individual’s consent except as mandated by law.
Student’s name __________________________________________________________ Date requested ____________________
Current address _____________________________________________________________________________________________
Street / Box number / Apartment
___________________________________________ _________________ ______________________
City State ZIP code
Phone number ( ) _______________________________ E-mail address ________________________________________
Date of Birth ___________________ Dates Attended _______________________________________________________________
Name while attending, if different than above ______________________________________________________________________
PLEASE READ CAREFULLY
• Ofcial transcripts will NOT be faxed to any recipients.
• Transcripts will NOT be e-mailed.
• Transcripts will NOT be issued if there is a hold on the student’s grades.
• Request are processed daily; however, during peak periods it may take 48-72 hours to process your request.
Which type of transcript do you need?
M Unofficial
M Official (Official transcripts cannot be faxed)
When would you like your transcript processed?
M Now
M Hold for final grades (Select only at end of semester)
How many transcripts would you like? ________
If you are requesting that transcripts be sent to more than one address/fax, please complete a separate Transcript Request form for each address/fax.
Select one or more delivery options:
M Pick up, Registrar’s Ofce, Student & Administrative Services Center, Room 1020
M Faxed to: ( ) ____________________________ (Official transcripts cannot be faxed)
M Mailed to:
Name ______________________________________________________________________________________________
Address ____________________________________________________________________________________________
____________________________________________________________________________________________
___________________________________________ _________________ ______________________
City State ZIP code
Student signature authorizing the issuance of the transcript ___________________________________________________________
DO NOT PRINT
Pennsylvania College
of Technology
Penn State (PSU) students:
This form is only for current students
and alumni of Penn College and its
predecessors in Williamsport, PA.
