PO Box 398, 609 Indian Ave., Poplar, Montana 59255
Phone: 406-768-6300
Fax: 406-768-6301
www.fpcc.edu
TRANSCRIPT REQUEST FORM
Please Print Clearly
STUDENT INFORMATION: Student ID#: ____________________________
Name: ____________________________________ Social Security #__________________________
Address: __________________________________ Maiden name or other names used:
__________________________________ ________________________________________
Phone number: _____________________________ Dates attended: ___________________________
E-mail Address: ___________________________________________________________________________
TYPE OF TRANSCRIPT REQUESTED: TRANSCRIPT FEES & RELATED CHARGES:
Unofficial Transcripts (FREE) Unofficial Transcripts FREE
Official Transcripts ($5.00) Official Transcripts $5.00
Official with Priority Mail ($12.00) Priority Mail – 2 day delivery $7.00
INSTRUCTIONS:
Mail Send transcript now
Pickup Send transcript after this term
Send transcript now & after term
MAIL TRANSCRIPT TO:
Name of College: ________________________________________________________________
Attention: ________________________________________________________________
Address: ________________________________________________________________
City, State, Zip: ________________________________________________________________
• Student account must be clear before transcripts may be sent.
• There is a charge per transcript for official transcripts.
• Must have proof of high school graduation or GED completion in student file.
• Payment of transcript fee must accompany request.
_____________________________________________ __________________________________
(Signature) (Date)
OFFICE USE ONLY:
Date request received________________________ Amount paid______________________________
Date request processed_______________________ Check#______ Money Order______ Cash ______
Date request mailed________________________ Receipt Number ___________________________
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