Student Records Office

Transcript Request
Print the form, complete it, and send to the Office of Student Records (800 Lakeshore Drive, Birmingham, AL 35229-7030), or fax it to (205) 726-2908. PLEASE TYPE OR PRINT CLEARLY.



 Current Name: __________________________________________________
                                           Last                                              First                                              Middle

 Student ID: __________________________ Date of Birth: ________________
                                 (Social Security Number OR Banner SUid)

 Maiden/Other Name(s): ________________ Last Year Attended Samford: _____


 Your Mailing Address: _____________________________________________

 ______________________________________________________________

 City: ____________________________ State: __________ Zip: ___________


 Daytime Phone: (_____) ______________ E-Mail: _______________________
                                                                           (In case we need to contact you)

 Student Signature: _________________________________ Date: __________
                                                                               (Required by FERPA)

 Please send one free copy of my transcript to the address below. Send it:

  ____ Now      ____ After current term's grades are posted      ____ When graduation is posted

 Address to send transcript to:

     ___________________________________________________________

     ___________________________________________________________

     ___________________________________________________________

     ___________________________________________________________

 For a faxed transcript, please provide the following information:

 Recipient's Fax No.: _________________________ Attn: ___________________

Please note that faxed transcripts are NOT considered official. Indicate clearly if you also want an official copy mailed to the fax recipient. If so, please provide the complete address in addition to the fax number.
 For Office Use Only:

 Holds checked by: __________ Date transcript sent: ______________ By: __________



Page maintained by Jane Leask, Assistant Registrar (Certifications, Publications, & Programming), jeleask@samford.edu.
Last update: 4/28/08 9:22 AM
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