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Get Ivy Tech Community College Transcript Request Form 2010

NAME ADDRESS INFORMATION Name last first middle name when enrolled Social Security or Student Date of Birth Month Day Year Address street city state zip Phone Number Student s Signature TRANSCRIPT SPECIAL INSTRUCTIONS check/complete all that apply Number of official transcripts mailed to the address below - 5. 00 per copy hold until current semester grades are posted hold until degree is posted attended Ivy Tech Community College prior to fall 1990 Name of Campus No charge for faxed transcripts at this time MAIL INFORMATION Name of College Attention METHOD OF PAYMENT PAYMENT MUST BE RECEIVED IN FULL PRIOR TO RELEASE OF TRANSCRIPTS Cash Amount Check Amount Check Credit Card Expiration Date Card Type MC Visa Discover Authorized Signature FOR OFFICE USE ONLY date received date completed processed by revised 1-09-10 vjm. TRANSCRIPT REQUEST FORM Registrar s Office PO Box 6299 Lafayette IN 47903-6299 TOLL FREE 888-IVY-LINE 888-489-5463 FAX 765-269-5280 ALL FINANCIAL OBLIGATIONS TO THE COLLEGE MUST BE PAID BEFORE TRANSCRIPTS ARE RELEASED. NAME ADDRESS INFORMATION Name last first middle name when enrolled Social Security or Student Date of Birth Month Day Year Address street city state zip Phone Number Student s Signature TRANSCRIPT SPECIAL INSTRUCTIONS check/complete all that apply Number of official transcripts mailed to the address below - 5. 00 per copy hold until current semester grades are posted hold until degree is posted attended Ivy Tech Community College prior to fall 1990 Name of Campus No charge for faxed transcripts at this time MAIL INFORMATION Name of College Attention METHOD OF PAYMENT PAYMENT MUST BE RECEIVED IN FULL PRIOR TO RELEASE OF TRANSCRIPTS Cash Amount Check Amount Check Credit Card Expiration Date Card Type MC Visa Discover Authorized Signature FOR OFFICE USE ONLY date received date completed processed by revised 1-09-10 vjm. TRANSCRIPT REQUEST FORM Registrar s Office PO Box 6299 Lafayette IN 47903-6299 TOLL FREE 888-IVY-LINE 888-489-5463 FAX 765-269-5280 ALL FINANCIAL OBLIGATIONS TO THE COLLEGE MUST BE PAID BEFORE TRANSCRIPTS ARE RELEASED. NAME ADDRESS INFORMATION Name last first middle name when enrolled Social Security or Student Date of Birth Month Day Year Address street city state zip Phone Number Student s Signature TRANSCRIPT SPECIAL INSTRUCTIONS check/complete all that apply Number of official transcripts mailed to the address below - 5. .

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