Please print clearly.
You must complete all information requested.
▪ Charge is $10 per transcript. Exact payment must
accompany each request unless the transcript is for NSU
internal use.
▪ For multiple requests, complete a transcript request form
and attach a list containing the name and mailing address for
each addressee.
▪ Fees are subject to change without notice.
▪ Transcripts will not be released with any existing hold(s) on
record or until all accounts are paid in full.
▪ Students are responsible for providing a correct mailing
address below. Any address correction charges incurred by
the university will be charged back to the student.
▪ The transcript is the student’s official and complete record of
all courses taken at Nova Southeastern University, regard-
less of number of degrees or programs attempted or
conferred. Partial records will not be released.
▪ NSU does not send transcripts electronically.
▪ When requesting a transcript please provide the complete
mailing instructions below (e.g., a department, building, room
number or to whom it should be addressed).
▪ Submit this completed form to the above address via postal
mail or fax.
Miami-Dade County Schools only
Include tuition reimbursement/FT 1 form for _______ term.
Print clearly
____________________________ __________________________
NSU ID Telephone
________________________________________________________
Present Name
_______________________________________________________
Name used at Nova Southeastern University
________________________________________________________
Address
________________________________________________________
City State ZIP
________________________________________________________
Email Address
Mail transcript to (if internal, indicate NSU department.)
________________________________________________________
Name
_______________________________________________________
1
st
Street Address
________________________________________________________
2
nd
Street Address
________________________________________________________
City State ZIP
_______________ ________________________________________
Number of Copies NSU Department
Social Security Number to be printed on the transcript
Print a masked SSN (ex. xxx-xx-1234)
Print full SSN
Special Instructions
I will pick up the transcript. Transcript will be stamped:
Official transcript issued to student
Notify me at (____) _______________________________
Hold for degree conferral__________________________
Degree Anticipated Conferral Date
Hold for grade __________________________________
Course
Mail transcript Other __________________________
Internal transcript (NSU Program____________________)
Domestic Express Overnight Delivery (no P.O. Box
address) ($9 plus $10 per transcript)
International Express Delivery (no P.O. Box address)
$24 plus $10 per transcript)
Method of Payment
Cash (only accepted at the One-Stop Shop)
Credit Card Check or money order payable to NSU
No charge (transcript for NSU internal use only.)
I hereby authorize a charge to be made to my credit card
VISA MasterCard American Express
________________________________________________________
Account Number
___________________________ ____________________________
Expiration Date Amount
________________________________________________________
Check/Money Order Number
________________________________________________________
Signature* (required) Date
*Your signature authorizes the release of transcripts and associated charges to
your credit card.
DATE OF REQUEST ______ /______ /______
FOR OFFICE USE ONLY
Transcript fee 2120
Amount due $___________ Amount remitted $_________
Amount rec. $___________ By:_______________________
Credit Bal./ref. $______________________________________
Date issued ________________ By:______________________
Hold reason _________________________________________
REV. 2/2019
