Student Information
Name: Last First Middle
ID Number/SSN Street Address
City State Zip Country
E-mail Daytime Phone
Name used while attending (if different)
Years attended to

Processing Request
Unless specified otherwise below, we will issue a complete, official Indiana University transcript including all enrollment.
Exceptions: Graduate course work only Law only Dentistry only  Medical Students: click here for form.
Sealed and Stamped Envelope Required
Send immediately
Hold until the grades for the current semester are on the transcript
Hold for grade change - Course number and semester/year taken:
Hold for degree -  Degree and date expected:

Payment Information
Number of copies (include $8 for each copy requested)
My check is enclosed made payable to IUPUI
I want to pay by Credit Card: Visa Master Card Discover
     Card Number    Expiration Date

Optional Express Delivery
I request domestic (within United States) express delivery at a cost of $35.00.
I request international express delivery at a cost of $55.00.
I authorize express delivery charges including a $10.00 processing fee to my federal express account.
     Account Number

Send Transcript To (complete only if transcript(s) to be mailed to other than home address)
Name
Address
           
City State Zip Country

Signature and Printing Instructions - This form must be completed, printed, signed and returned with payment to the Registrar's Office either by fax or by mail.