BUFFALO STATE TRANSCRIPT REQUEST FORM

Complete this webform, then print this page with your web browser,  sign it, attach a check or money order in the exact amount of $5 per transcript made payable to Buffalo State. Transcripts are mailed via US mail. For overnight or faster delivery, students need to provide a prepaid envelope from a mail service such as Fed Ex, UPS, etc., along with their transcript request. Mail to:

Transcript Office: Moot Hall Room 210
Buffalo State
1300 Elmwood Avenue
Buffalo, NY 14222-1095

Todays Date:  SSN #      Banner ID Number

Your Name: Date of Birth
Name While Attending BSC (If different)

Current Address: Daytime Phone Number:

Are you currently enrolled at Buffalo State?

What year did you last attend Buffalo State?

If you are a graduate of Buffalo State, indicate month/year you received the following

Bachelors              Masters  _____________________________________________________________________________
Request Unofficial Transcript_______ Request Official Transcript__________

Name and Mailing Address of the Transcript Recipient?

Special Instructions : Do Not Mail Until:

Posting of Current Grades (pick one)       Posting of: (pick one)  

Student Pick-Up_____
*Student Official Transcript Pick-up Requests will be issued in a sealed envelope. Transcripts are considered unofficial if envelope opened by student.

I Authorize the release of my Transcript Record

Signature _______________________________________________________________