Are you currently enrolled at SUNY Orange Yes No
If not currently enrolled please indicate approx. date of last attendance _______________
TRANSCRIPT PROCESSING INSTRUCTIONS ( CHECK ONLY ONE)
NOW – Do not hold for grades or notation of degree
Hold for current semester grades. (Check one) ____Fall ____ Spring ____ Summer
Hold for notation of degree
PRINT BELOW THE NAME AND/OR OFFICE AND ADDRESS WHERE YOU WANT THE TRANSCRIPT SENT
Number of Copies to be sent to the below address: ________ ( Calculate fee of $5.00 per copy)
DO NOT WRITE BELOW THIS LINE* FOR OFFICE USE ONLY
Bursar Fee Paid___________________
Initials ___________________________
Date _____________________________
Date Processed ________________
Initials_________________________
Notes:
Revised 4/20/10
Student’s Current Address:
Student ID#: A ___ ___ ___ ___ ___ ___ ___ ___
(OR)
SSN ID#: ___ ___ ___ - ___ ___ - ___ ___ ___ ___
SUNY Orange
Records & Registration
115 South Street
Middletown, NY 10940
Tel: 845-341-4155
Fax: 845-342-8662
Print and complete form then mail or fax with the
appropriate fee to Records & Registration.
Checklist: Please be sure to include:
Sign the request
Requester is responsible for complete and accurate address
Please include $5.00 in the form of a check/MO or credit card information for a
Master Card or Visa, Discover for each transcript requested. Please make the
check/MO payable to SUNY Orange
Your Tel Number with your request
If applying in person be sure to have picture ID
Please be aware transcripts are processed in the order in which they are received
and will take approximately 7-10 working days.
If paying by credit card please include the following:
VISA Master Card Discover
Name on Card:_____________________________________________
Credit Card Number:_______________________________________
Expiration Date: ___________________________________________
*Billing information (if different from above)
Street Address______________________________________________
City/State/Zip______________________________________________
