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Sign After Printing: Transcript Request Form

This document is a transcript request form for California State Polytechnic University, Pomona. It requests the student's personal information such as name, student ID number, dates of attendance, and contact information. The form allows the student to request transcripts be sent now, held until a future date like grade changes or degree posting, or picked up in person. The student can also request information about extension classes be included. Payment for transcripts is required before the request can be processed.

Uploaded by

oooch
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
38 views

Sign After Printing: Transcript Request Form

This document is a transcript request form for California State Polytechnic University, Pomona. It requests the student's personal information such as name, student ID number, dates of attendance, and contact information. The form allows the student to request transcripts be sent now, held until a future date like grade changes or degree posting, or picked up in person. The student can also request information about extension classes be included. Payment for transcripts is required before the request can be processed.

Uploaded by

oooch
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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CALIFORNIA STATE POLYTECHNIC UNIVERSITY, POMONA Registrars Office


Cashiers
Receipt #

FOR OFFICE USE ONLY Records Svc Ind


Initials Date

TRANSCRIPT REQUEST FORM


Payment for transcript(s) is required prior to submitting request to the Registrars Office. All outstanding fees owed to the university must be paid before your transcript order can be processed.

Name

Last No. & Street

First City State

MI

BroncoNumber

(or SSN if BroncoNumber unknown)

Present Address Date of Birth

Zip Code

Contact Phone No. Major

(MM/DD/YYYY)

E-mail

If your records are under a different name, specify: Approximate First Quarter/Year at CPP? Approximate Last Quarter/Year at CPP? Check all that apply below: Process Now Other
Specify:

Fall Fall

Winter Winter

Spring Spring

Summer Summer
(Year)

Hold Until: Grade change processed


Specify Course(s):

Extension Classes Taken


(Cal Poly Ext. Univ. Kellogg West)

Total # of extension classes: Specify:


Term / Year Term / Year Term / Year

Please Note: Holds on a students record will delay processing.

Repeated course processed


Specify Course(s):

Degree posted End of quarter


(Allow three weeks after quarter ends.)

Cal State Teach Submitting your request in-person at: Registrars Office, CLA Bldg. 98-2 Cal Poly Pomona 3801 W. Temple Ave. Pomona, CA 91768
nd

Transcript Fee $6 x

# Transcripts Ordered =

Total Paid

(Make check/money orders payable to Cal Poly Pomona)

floor

Number of copies to be mailed: Number of copies to be picked-up:


(Photo ID Required for pick-up)

Signature:

SIGN AFTER PRINTING

Date:

If transcripts are to be mailed to more than one address, please complete an additional window insert below for each address:

---------------------------------------------------------------------------------------Name
Last First MI

BroncoNumber

Print clearly the name and address where transcript is to be sent for direct mailing. If no address is provided, transcript will be sent to the address given above.
FOR OFFICE USE ONLY

Mail Pick-Up
Rev. 07/2012

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