Request for Academic Records
Note to Applicant: It is the responsibility of individual applicants to have their academic records forwarded to WES. Please
complete the top part of this form and submit it to the registrar/controller of examinations/or other authorized official at the
academic institution where you obtained your credential(s). Print additional copies of this form if necessary. Please note that
some institutions may charge a fee for this service.
WES Ref # (if applicable)
Last/Family Name First/Given Name
Previous Name (if applicable) Date of Birth (dd/mm/yyyy) E-mail
Institution Name Dates Attended
From_____________________ To ____________________
(mm/yyyy) (mm/yyyy)
Degree Name (if applicable) Year of Award (if applicable) Major
Student ID or Roll Number at sending institution (if applicable)
I hereby authorize the release of my academic records to World Education Services.
Applicant’s Signature: Date:
Note to Authorized Official: The above-named person seeks to have his/her credentials evaluated and requests that a transcript
of his/her academic records/statement of marks - showing all subjects completed and all grades/marks awarded for all years of
study - be released to World Education Services. Please complete this form, place the form and academic record in an envelope,
sign and seal the envelope across the back flap, and send it directly to World Education Services at one of the addresses below.
Name of Official Completing Form (Please type or print) Title
Address
City Country Postal Code
Telephone Fax
Email URL
www.
Confirmation: I confirm that the student named above attended
Institution Name
Dates of attendance from to
month/yr month/yr
Degree obtained (if applicable) __________________________________________________ _____________________
Degree Name Date Awarded (month/yr)
Authorized signature and SEAL Date