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Form 501 Print

This document is a transcript request form from Purdue University. It provides instructions for students and alumni to request academic transcripts from Purdue for free, up to 10 transcripts per request and 50 per term. The form collects the requestor's contact information and up to 3 transcript requests, specifying the number of transcripts, pick up or mailing instructions, and any special handling for each request. A reminder is provided that falsifying transcripts is illegal.

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66 views2 pages

Form 501 Print

This document is a transcript request form from Purdue University. It provides instructions for students and alumni to request academic transcripts from Purdue for free, up to 10 transcripts per request and 50 per term. The form collects the requestor's contact information and up to 3 transcript requests, specifying the number of transcripts, pick up or mailing instructions, and any special handling for each request. A reminder is provided that falsifying transcripts is illegal.

Uploaded by

wish u
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PURDUE UNIVERSITY OFFICE OF THE REGISTRAR

610 Purdue Mall West Lafayette, IN 47907-2040 (Campus Location: Ground Floor, Hovde Hall) (FAX Number: (765) 494-0570)

ACADEMIC TRANSCRIPT REQUEST


Reg. Form 501- Rev. 08/2012

TRANSCRIPTS ARE PROVIDED AT NO CHARGE

PLEASE PRINT
(1) NAME ________________________________________________________________(2) PUID/STUDENT ID# ___________________________
LAST FIRST MIDDLE

__________________________________________________________________________________
MAIDEN NAME OR OTHER NAME UNDER WHICH RECORDS MAY BE FOUND

(3) ADDRESS _____________________________________________________________ (4) DATE OF BIRTH STREET

CITY DAYTIME TELEPHONE NUMBER

STATE E-MAIL ADDRESS

ZIP CODE

(5) I LAST ATTENDED PURDUE IN __________ (Year) (6) WRITTEN SIGNATURE __________________________________________________ (7) DATE ___________________________

AS A SERVICE TO ITS STUDENTS AND ALUMNI, PURDUE UNIVERSITY PROVIDES ACADEMIC TRANSCRIPTS AT NO CHARGE. EACH STUDENT/ALUMNUS IS LIMITED TO 10 TRANSCRIPTS PER REQUEST AND 50 TRANSCRIPTS PER TERM. MAIL OR FAX COMPLETED FORM TO ADDRESS OR FAX NUMBER LISTED ABOVE. YOU ALSO MAY SEND A SIGNED, SCANNED COPY OF THIS FORM VIA E-MAIL TO [email protected]
REQUEST #1 NUMBER OF TRANSCRIPTS FOR THIS REQUEST __________
PICK UP (Must be claimed within 10 working days; picture ID required to pick up) ______HOLD FOR CURRENT SESSION PURDUE DEGREE

______ISSUE TRANSCRIPT(S) NOW ______HOLD FOR CURRENT SESSION GRADES

RECIPIENT NAME RECIPIENT ADDRESS

SPECIAL HANDLING INSTRUCTIONS (if any) ______INCLUDE ATTACHMENT (Attach attachment to this form) ______INSERT EACH TRANSCRIPT IN AN INDIVIDUAL ENVELOPE ______OTHER

______ CHECK HERE IF MAKING ADDITIONAL REQUEST(S) ON REVERSE SIDE.

NAME
LAST FIRST MIDDLE

PUID/STUDENT ID# NUMBER OF TRANSCRIPTS FOR THIS REQUEST __________


PICK UP (Must be claimed within 10 working days; picture ID required to pick up) ______HOLD FOR CURRENT SESSION PURDUE DEGREE

REQUEST #2

______ISSUE TRANSCRIPT(S) NOW ______HOLD FOR CURRENT SESSION GRADES

RECIPIENT NAME RECIPIENT ADDRESS

SPECIAL HANDLING INSTRUCTIONS (if any) ______INCLUDE ATTACHMENT (Attach attachment to this form) ______INSERT EACH TRANSCRIPT IN AN INDIVIDUAL ENVELOPE ______OTHER

REQUEST #3

NUMBER OF TRANSCRIPTS FOR THIS REQUEST __________


PICK UP (Must be claimed within 10 working days; picture ID required to pick up) ______HOLD FOR CURRENT SESSION PURDUE DEGREE

______ISSUE TRANSCRIPT(S) NOW ______HOLD FOR CURRENT SESSION GRADES

RECIPIENT NAME RECIPIENT ADDRESS

SPECIAL HANDLING INSTRUCTIONS (if any) ______INCLUDE ATTACHMENT (Attach attachment to this form) ______INSERT EACH TRANSCRIPT IN AN INDIVIDUAL ENVELOPE ______OTHER

REMINDER: The Indiana Code states that a person who falsifies a college transcript or diploma with the intent to obtain employment or an educational opportunity commits deception, a Class A misdemeanor. A person who commits a Class A misdemeanor shall be imprisoned for a fixed term of not more than one (1) year; in addition, he may be fined not more than five thousand dollars ($5,000).

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