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, and mail to:

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

Todays Date:      Social Security Number:

Your Name:
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 

Complete Mailing Address of the Transcript recipient?

Special Instructions : Do Not Mail Until:


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

I Authorize the release of my Transcript Record


Signature _______________________________________________________________