Peralta Community College District
Transcript Request Form
TRANSCRIPT REQUEST INFORMATION
Processing Types and Fees:
 Regular Delivery - $6.00 per copy (includes $4.00 per transcript plus $2.00 handling charge) - mailed within 7-10 business days.
 Rush Delivery - $12.00 per copy (includes $10.00 per transcript plus $2.00 handling charge) – mailed within 3-5 business days.
 Pick-up processing - $12.00 per copy (includes $10.00 per transcript plus $2.00 handling charge) - students pick-up transcripts at the
District A&R Office in 2 business days.
 Free Transcripts - Student’s first two transcripts requested are free.
NOTE: The $2.00 handling charge applies to all free transcripts
 Prior to 1970 processing – Allow up to 20 days (there is no rush for prior 1970 records).
 Same day transcripts are not available.
In-Person/Mailed transcript requests will not be issued/processed if any of the following criteria are not met:
 Signed and dated written request from student. (Requests made online require an electronic signature.)
 A mailed transcript request must have payment included. Check or money-orders only. Do NOT mail cash or credit card information.
 All Peralta debts must be paid and all holds, including financial holds, must be cleared before transcript requests can be processed.
STUDENT INFORMATION
Please print clearly:
Did you attend prior to Fall 1970?
YES
Name:
NO
Date of Birth:
Last
First
M.I.
Other names used at Peralta:
Address:
No. & Street
City
Email Address:
State
Zip Code
Phone #:
Student ID# OR SSN:
Dates of Attendance:
From
To
SEND TRANSCRIPTS TO:
REQUEST #1
Select the Processing Type:
Number of copies:
Regular
Rush
Pick-Up
MAIL TO:
Address:
No. & Street
REQUEST #2
City
State
Select the Processing Type:
Number of copies:
Regular
Zip Code
Rush
Pick-Up
MAIL TO:
Address:
No. & Street
City
State
Zip Code
X
Student Signature
Date
ADMISSIONS & RECORDS/CASHIER OFFICE USE ONLY
PROCESSED?
YES
NO
REQUEST #1:
MAIL
PICK-UP
Amount Due:
$
REASON:
RUSH
$
PICK-UP
RUSH
Date
X
Cashiers Initials
Rev.: JBW 10/2010
MAIL
X
A&R Initials
Amount Paid:
REQUEST #2:
Date