Official Transcript Request - Kalamazoo Valley Transcript... · Official Transcript Request ... information,…

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  • Admissions, Registration and Records PO Box 4070, Kalamazoo, MI 49003-4070 f: 269.488.4199 p: 269.488.4281

    Official Transcript Request

    Completed forms will first be processed in Financial Services. Once payment is made and credit card information is removed, the transcript will be generated by the Admissions, Registration and Records office. To protect your information, do not e-mail transcript requests as e-mails are not secure. It is safest to mail, fax or deliver it in person.

    Student Information and Authorization

    Last Name First Name Middle Initial

    Valley Identification Number (if known)

    V

    Street Address

    City State Zip code

    Home Phone

    Alternative Phone

    Previous name used at KVCC

    Date of Birth

    Student Signature (required)

    Date

    Select a processing timeframe Select a delivery method

    Number of Transcripts: _____ x $3.00 each = ________ Normal processing time is 1-2 business day or same day for pick up.

    Process Immediately

    After class ends in _______________ (month) and grades are posted (approx. 1 week later)

    After my grade has been changed Semester: _________________

    Course: _________________

    Original Grade: _________________

    After my record has been audited for Michigan Transfer Agreement compliance

    After my degree is audited and posted (approx.. 2 weeks after your final semester)

    I will pick up my transcript (photo ID required) I authorize the following person to pick up my transcript

    (they will be required to present photo ID)

    ____________________________________________

    Mail my transcript to my address listed above Mail my transcript to:

    Name/Dept.: __________________________________________

    School/Business: ______________________________________

    Address:

    _________________________________________________

    _________________________________________________

    _________________________________________________

    City State Zip code

    Release Notice

    Transcripts are only released by written request of the student, in compliance with the Family Educational Rights and Privacy Act. Transcripts will not be furnished to any student whose financial obligation to the College has not been satisfied. For more details please reference our Release of Information policy and Notice of FERPA Rights published on our website.

    Academy, Specialized training, CEU classes

    I took a non-credit academy or class with continuing education units (CEU). Include my CEU transcript and transfer credit detail.

    Office Processing

    Financial Services:

    ____/____/____ ______ Date Processed Initials

    Records Office:

    ____/____/____ ______ Date Processed Initials

    Hold/Other _____________________________________

    Date Notified ____/____/____

    Payment information (Will be removed and shredded by Financial Services after processing)

    If mailing or faxing this request and paying by credit card (Discover, MasterCard, Visa), please provide your information below.

    Credit Card Number: _____________________________________________ Expiration Date: __________________________

    Card Holders Name: ________________________________________________________

    KVCCNoteTo protect your personal information, please reset this form to clear all fields. This is especially important if you are using a public or shared computer.

    Note: This feature may not work if your browser uses its own .pdf viewer and does not open the document in Acrobat Reader. You either need to print from your browser and make sure the form is cleared, or activate the Adobe Acrobat Plug-in on your browser.

    Reset Form: Last name: First name: Middle initial: Valley number: Street address: City: State: Zip code: Home phone: Alternate phone: Previous name: Birthdate: Number of transcripts: [1]Cost: [$3.00]Same day: After class end: Month: [Select Month]After grade is changed: Semester and year: Course: Grade: [Select Grade]After MTA Audit: After degree is posted: Pickup: Authorized Person: Authorized person's name: Mail to student: Mail: Attention 1: Attention 2: Address line 1: Address line 2: City, State, Zip code: CEU: Credit card number: Expiration date: Card holder's name: