Transcript Request Form

BUFFALO STATE COLLEGE 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 College. 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 College
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 College?

What year did you last attend Buffalo State College?

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 _______________________________________________________________