Transcript Request Form

Transcript Request Form
1900 West Olney Avenue – Box 818
Philadelphia, PA 19141
Personal Information:
Name: ________________________________________ Maiden Name: ____________________________
Student ID# or SS#: _____________________________ Date of Birth: _____________________________
E-mail Address: ________________________________ Home Phone: _____________________________
Are you currently enrolled at La Salle? ___ Yes ___ No, Dates of Attendance: ______________________
Please indicate the number of transcripts per level that you are requesting:
Undergraduate: _____________ Graduate: _____________ Doctoral: _____________ CEU: ___________
** All levels of transcripts are recorded on separate documents. Each transcript is $5 per copy payable
by check, cash or money order.
Send Transcript(s): ____ Immediately upon receipt of request
____ After final grades are posted
____ After degree has been conferred
Reason for Transcript (s): __employment
__study abroad
__graduate school
__ self /other: ________________
Please print the address where you would like to have your transcript(s) sent. Include a department and/or
contact person where applicable:
Signature: ______________________________________________ Date: ____________________________
* Please allow up to five business days for processing. No request will be honored for those individuals
with outstanding balances owed to La Salle University. Please make checks and money orders payable to
La Salle University.