APPLICANT:
Please complete this form, print it and send it to the registrar of ALL colleges, universities, professional and technical
schools previously attended. Be sure to check the box below indicating which FDU campus you wish to receive your
transcripts. Submit this form as soon as possible so that the transcript will be sent directly to Fairleigh Dickinson
University in time to complete your application before the appropriate deadline. This form is print-ready.
Name ______________________________________________________________________________________________________
Last First M.I. Maiden Name
Social Security No. (last 4 digits only; optional)
쏔쏔쏔쏔
Date of Birth __ __/__ __/__ __ __ __
Degree Earned ______________________________________________________________________________________________
Date Degree Earned __________________________________________________________________________________________
I hereby authorize the release of this transcript of my academic record to Fairleigh Dickinson University.
______________________________________________________________________________________ ____________________
Applicant’s Signature Date
REGISTRAR:
The above named person is applying for admission to Fairleigh Dickinson University.
Please enclose this form with an official transcript in a sealed envelope, and
send the transcript to the following address:
TRANSCRIPT REQUEST FORM
왏 Metropolitan Campus
Graduate Admissions Office
Fairleigh Dickinson University
1000 River Road, T-KB1-01
Teaneck, NJ 07666
왏 Florham Campus
Graduate Admissions Office
Fairleigh Dickinson University
285 Madison Avenue, M-RI0-01
Madison, NJ 07940
