Lincoln Memorial University
Transcript Request
Office of the Registrar
Box 2002
Harrogate, TN 37752
Phone : 423-869-6313 Fax: 423-869-6387
Email: jennifer.ellis@lmunet.edu
Official Transcripts are $4.00 each
Transcripts cannot be faxed
or sent electronically.
Name:
Date:
Student ID:
Phone:
Maiden or other names:
Dates of Enrollment: (Check all that apply)
Date of Birth:
1964 to 1980
1980 to Summer 2004
Fall 2004 to Present
Address:
Select type of Transcript
Mail transcript: (Check all that apply)
(Check all that apply)
Undergrad
Immediately
Grad: MBA, MED, EDS
After current grades are available
Prof: EDD, JD, or DO
After degree is posted
After Grade Change
(specify course)
Accounts must be paid in full prior to the release of any transcripts. If you received a loan
through LMU and are past due, transcripts cannot be released.
Print legibly the complete name(s) & address(s) of the person/institution(s) you wish to receive transcripts.
Number of transcripts to be picked-up in office.
Send
transcripts(s) to the address below.
(number of copies)
_____ Official
Send
transcripts(s) to the address below.
(number of copies)
_____ Unofficial (No charge)
(Please list company/institution/recipient name and address)
Official transcripts are $4.00 per copy.
_____ Official
_____ Unofficial (No charge)
(Please list company/institution/recipient name and address)
Transcripts cannot be faxed
or sent electronically.
Signature
(required)
If you are faxing the request, provide Credit Card # :
Exp Date:
Security code:
For Office Use Only:
Amount Pd:
Date mailed:
Cash
Check#
Charged to credit card
Date picked-up:
Rev: 12/14