University of Bridgeport
Registrar’s Office
126 Park Avenue
Bridgeport, CT 06604
Phone: 203.576.4642
Fax: 203.576.4949
University of Bridgeport Transcript Request
Date: ___________________________ Student Number: ______________________________
Student Name: _________________________________________________________________
Maiden/Former Name (s): ________________________________________________________
Current Address: _______________________________________________________________
City: ___________________________________State:___________________ Zip:___________
Contact Information:
Phone: ____________________________ Email: _____________________________________
Are you currently enrolled? Yes ( ) No ( )
Dates of attendance:______________________________ Did you graduate? Yes ( ) No ( )
What program/s did you attend? ___________________________________________________
When do you wish the transcript to be sent?
Immediately ( ) End of term ( ) After Degree Certification ( )
Transcript/s is to be sent to:
Recipient 1:_________________________ Recipient 2:_______________________________
__________________________ ________________________
__________________________ ________________________
__________________________ ________________________
Number of copies: __________________ Cost is $5 per official transcript.
Request forms must be submitted with payment.
Signature: ________________________________________________________
We will contact you when your transcript is ready to be picked up. Only students who have indicated
pick up in the recipient area. All financial Obligations must be met prior to the issuance of official
transcripts.
Please provide your credit card information: Type: M/C Visa Amex Discover
No: ____________________________ Exp: ________ CSC: _____ On back of card.