Oglala Lakota College
TRANSCRIPT REQUEST FORM
Registrar’s Office
PO Box 490
490 Piya Wiconi Road
Kyle, South Dakota 57752-0490
Telephone (605)455-6033
Fax (605)455-2226
OFFICE USE ONLY:
Approved_____ Disapproved_____
Student Accts______ Date_________
Processed By:______ Date_________
Official Transcripts will be issued upon receipt of the NON-REFUNDABLE fee of $5.00 for the first official copy and $2.00 for each
additional copy, per request, payable to OLC. If you would like your transcripts faxed, there is an added fee of $2.00 each, per
transcript, per request.
NAME______________________________________
(Other Names Used) _____________________
SSN/Student ID____________
Address:____________________________________________________________________________________________________
Street/Apt.
City
State
Zip
Phone Number:_________________________Email:___________________________________________________________________
Number
of Copies ______
Now
After grades are posted
After degree is posted
Purpose of
Transcript
Release:
Name: ________________________________
Address: _______________________________
Graduate/Professional School
Job Application
Licensure/Certification
Personal Records
Transfer to another school
Higher Education/Scholarships
________________________________
Number
of Copies ______
Now
After grades are posted
After degree is posted
Please Fax my
transcripts to this number:________________________
Faxed transcripts are considered unofficial.
Name: ________________________________
Please allow the following
person to pick up my transcripts:____________________
Address: _______________________________
________________________________
Use a separate sheet of paper for additional addresses, if needed. If there are any holds on your record, an official transcript
cannot be issued until all holds are cleared. If a balance is owed, a new request must be submitted when balance is cleared.
_______________________________________
STUDENT SIGNATURE
(Must be signed to release)
Method of Payment
Card Number: ________
________
____________________________________
DATE
Cash
Money Order
Check
Visa
Discover
MasterCard
________
________
Check #______
Expiration Date: ________
CVS#________
Name on card_________________________________________
Card Holder’s Address: ____________________________________________________________________________
Rev. 6/3/2014