Transcript Request Form
Please print this form and give it to the Registrar’s Office at your current or previous institution with the
transcript fee (if required) to request that your official transcript be mailed to Coastal Carolina University at
the following address:
Coastal Carolina University
Office of Admissions
P.O. Box 261954
Conway, SC 29528-6054
Student Information
Name of College or University:
Student’s Name:
Maiden or Other Names (if applicable):
Date of Birth: Student ID Number:
Dates Attended: From: To:
Term Applied to Enter Coastal Carolina University:
Fall 20___ Spring 20___ Summer I 20___ Summer II 20___
Maymester 20___
Transcript Release Authorization
My signature below authorizes the release of my transcripts. I understand that it is my responsibility to
request any and all transcripts to complete my application to Coastal Carolina University. I understand that I
am responsible for any charges for the release of these transcripts to Coastal Carolina University.
Student’s Signature:
Mailing Address:
City: State: ZIP:
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