STUDENT INFORMATION
(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:
YES NO
Branch of Service: (Check one):
Army Air Force
Navy Coast Guard
Other (Specify):
USU School Attended:
Dates Attended USU:
Start: End:
Graduation Date:
Telephone Number: Alternate Number: Email Address:
Current Address: Apt. #
Current Address continued:
City, State: Zip Code: Country (if not U.S.):
REQUEST INFORMATION
Students are responsible for providing accurate address information for third party recipients
Third Party Addresses Only
Delivery Method:
ADDRESS 1:
ADDRESS 2:
CITY
STATE:
ZIP CODE:
COUNTRY (other than U.S.)
MAIL TO:
SIGNATURE:
DATE:
**NOTE: Must have signature to process. Digital signatures accepted for
online submission.
Marine Corps
The Uniformed Services University of the Health
Sciences
Official Transcript Request Form
Please complete this form and email to: registrar@usuhs.edu
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
processing.
• 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:
Send Transcripts:
Student Pick-Up Mail
Official Military Requirement
Now, do not hold
Hold until grades are posted
Hold until degree is awarded
Hold until date:
