Union Bible College & Academy

Departments

Please fill out this form as completely as possible.

Name and Personal Information

First Name:
Middle Name:
Maiden Name (if applicable):
Last Name:
Date of Birth:
SSN:
Daytime Phone Number:
Email Address:

Are you currently enrolled?

: Yes
: No
If not currently enrolled, date you were last enrolled:

I hereby authorize Union Bible College & Academy to send an official copy to the following address.

Complete separate requests for each additional address.

Mail Transcript To:

Name:
Address 1:
Address 2:
City:
State:
Zip Code:

Your Name and Mailing Address:

Name:
Address 1:
Address 2:
City:
State:
Zip Code:

Quantity and Delivery

: Number of transcripts you are requesting to address
: Mail now
: Pick up
Pick up date:

Hold Transcript

: Do not Hold
: Hold for Current Term's Grades
Term and Academic Year:
: Hold for Degree
Degree and Graduation Year:
: Hold for Grade Change
Department:
Class Number:
Class Term and Year:

Payment

: Paid $5.00 Fee (contact Business Office)
: No Charge (first transcript)

Family Education Rights and Privacy Act of 1974 Section 438(4) B Personal information shall only be transferred to a third party on the condition that such party will not permit any other party to have access to such information without the written consent of the student.

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