(Please type or print legibly if form is printed for completion)
Last Name: First Name: MI:
IF DIFFERENT, LIST NAME UNDER WHICH ENROLLED:
Date of Birth: (MONTH/DAY/YEAR) SSN (Last FOUR ONLY):
Currently Active Duty:
Branch of Service: (Check one):
Army Air Force
Navy Coast Guard
USU School Attended:
Dates Attended USU:
Telephone Number: Alternate Number: Email Address:
Current Address: Apt. #
Current Address continued:
City, State: Zip Code: Country (if not U.S.):
Students are responsible for providing accurate address information for third party recipients
Third Party Addresses Only
COUNTRY (other than U.S.)
**NOTE: Must have signature to process. Digital signatures accepted for
The Uniformed Services University of the Health
Official Transcript Request Form
Please complete this form and email to: firstname.lastname@example.org
Email subject line: Transcript Request
• Official Transcripts will not be faxed/
email or sent to student home addresses.
• Unofficial Transcripts can be emailed to
student upon request.
• Please allow up to 3-7 business days for
• Complete one form for each request.
• There is no charge for sending a transcript.
• Transcripts will not be released without
signature (CAC signature accepted).
OFFICIAL USE ONLY:
Date Transcript Mailed:
FOR OFFICIAL USE ONLY- Privacy Sensitive
Any unauthorized disclosure may result in both civil and criminal penalties.
Reason for Request:
Student Pick-Up Mail
Official Military Requirement
Now, do not hold
Hold until grades are posted
Hold until degree is awarded
Hold until date: