Transcript Request Form Contact our Finance Office at finance@galen.edu.bz for mailing cost PERSONAL INFORMATION **Legal Name (Please enter your name as it appears on your passport and/or other official documents.) Last Name: First Name: Middle Name: Birthdate: e-mail: 2. ACADEMIC INFORMATION Student ID #: Academic Program Cell #: Transcript Type and Special Instructions (check/complete all that apply) Standard Official - $20.00 (each)Expedited Official - $30.00 (each) Quantity needed: * Standard (3-5 working days) * Expedited (same day; request received by noon) Recipient Information (select option) —Please choose an option—To be mailed toTo be sent electronically to university, employer, etc. toTo be picked up/received in person * To be mailed to: Name and/or Title #: Name of University/College/Business: Mailing Address: Number and Street: Town/ City: District/ State : Zip Code: Country: * To be sent electronically to university, employer, etc. to: Email Address: * To be picked up/received in person: (must be retrieved within 90 days) Purpose for request (please check one) Scholarship/grantEmployment verificationGuest at other UniversityDegree completionEnrollment verificationGraduate ProgramTransferringPersonal Note: All financial obligations to the University must be paid before any documents are released.
