Business Oce Use Only:
q Holds Cleared
q Transcript Fees Paid
Receipt # _____________
Address Change: q Y or q N
Employee Initials _______
q EC q OC q WC
TRANSCRIPT REQUEST FORM
THIS FORM IS ONLY TO BE USED IF PAYING THE TRANSCRIPT FEE(S)
WITH CASH, CHECK OR MONEY ORDER.
Please make check or money order payable to: Valencia College
PLEASE NOTE - Transcripts will not be released if:
1. There is a hold on your student record.
2. There is a pending balance with the Finance Oce or the Library.
3. The non-refundable transcript fee of $3.00 per transcript has not been paid.
Student Valencia ID/Social Security Number Date
Last Name (At the time of your attendance) First Name Middle Initial Date of Birth
Street Address
City State Zip Telephone
Can we use this to update your address? q Yes q No
When do you want your transcript(s) processed? (Please check one)
q Immediately
q Hold for Final Grades (Must be requested before the last day of the term.)
q Hold for Degree (Must be requested before the last day of the term.)
You must sign this form before your request may be processed.
Student Signature Total Number of Transcripts
Please print clearly, in the space below, the complete name and address of where you want your transcript(s)
sent. Fill out a separate request forms for each address to which you are sending transcripts.
MAILING ADDRESS FOR TRANSCRIPT(S)
Institution Name:
Contact/Dept. Name:
Address:
City, State Zip
This form can be delivered to the Business Oce on any campus or mailed to:
Valencia College
Attn: Business Oce, Mail Code 3-11
701 N. Econlockhatchee Trail
Orlando, FL 32825
© 2016 Valencia College | 16ADM001
