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Transcript Request Form

The document is a Transcript Request Form for Palau Community College, requiring student information, payment details, and transcript request specifics. It outlines the fees for regular and rush processing, payment methods, and policies regarding transcript release. Additionally, it emphasizes that transcripts will not be released if the student has any obligations to the college.

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5 views1 page

Transcript Request Form

The document is a Transcript Request Form for Palau Community College, requiring student information, payment details, and transcript request specifics. It outlines the fees for regular and rush processing, payment methods, and policies regarding transcript release. Additionally, it emphasizes that transcripts will not be released if the student has any obligations to the college.

Uploaded by

mustafecabdirisaaq850
Copyright
© © All Rights Reserved
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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Registration & Records Office

P.O. Box 9, Koror, Palau 96940


Phone: (680)488-2470 Fax: (680)488-5112 Email: [email protected]

TRANSCRIPT REQUEST FORM


STUDENT INFORMATION – Required to identify your record (Please Print)
Social Security Number Date of Birth

Full Name (Last, First, Middle)

PO Box or Street Address City State ZIP Code

First Term Attended Last Term Attended Phone Email Address

TRANSCRIPT FEES - Payment by check, money order (payable to Palau Community College), cash, or credit card is required in advance.
PROCESS FEE QTY TOTAL FEE
Regular Processing (2-5 business days) $3.00 $
Rush (1 business day) $5.00 $

CREDIT CARD PAYMENT INFORMATION


Cardholder’s Name Credit Card Number Exp Date (mm/yyyy)

Authorized Amount to Charge Credit Card Type Card Code (last 3 or 4 digits in signature block)

VISA MasterCard
Cardholder’s Billing Address Cardholder’s Daytime Phone

TRANSCRIPT REQUEST INFORMATION


Request #1) Number of copies for the request below: ________ Request #3) Number of copies for the request below: ________
Regular Rush Send after ____________ semester grades are posted Regular Rush Send after ____________ semester grades are posted
Hold for pick up by: ___________________________________________ Hold for pick up by: ___________________________________________
Mail/Address to: ______________________________________________ Mail/Address to: ______________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
OFFICE USE ONLY Request #1 – Send by/date _____________________ OFFICE USE ONLY Request #3 – Send by/date _____________________

Request #2) Number of copies for the request below: ________ Request #4) Number of copies for the request below: ________
Regular Rush Send after ____________ semester grades are posted Regular Rush Send after ____________ semester grades are posted
Hold for pick up by: ___________________________________________ Hold for pick up by: ___________________________________________
Mail/Address to: ______________________________________________ Mail/Address to: ______________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
OFFICE USE ONLY Request #2 – Send by/date _____________________ OFFICE USE ONLY Request #4 – Send by/date _____________________

Signature _______________________________________________________________ Date of Request __________________________________


Authorization Signature Required: I authorize release of my transcript as directed on this Transcript Request Form.

Transcript Policies For office use only


• Transcripts will not be released to students with obligations (account
balances, administrative holds) to the college. Receipt Number: _________ Amount paid: __________ Date: __________
• Transcripts are issued at the request of the student with their authorized
Financial Clearance: ________________ Initial: ____________________
signature. Transcripts will not be released to a third party without the
written consent of the student. Date processed: ____________________ Initial: ____________________
• Official transcripts of credits earned at other institutions are not
available for distribution by Palau Community College.  mailed  emailed  delivered picked-up  faxed
• A photo ID must be presented upon pick up of transcripts.

Revised 07.18.2016

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