8/16/2019 Tran Form Pdfdelivery

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Transcript Request Form - Electronic Transcript Delivery (PDF) 

T h i s fo r m i s f o r f a x o r m a i l u s e o n l y  . Complete this form online then print for faxing or mailing with payment. For in-person requests 

there is a request form available in the Office of the Registrar. All valid transcript requests received by the Office of the Registrar are 

processed and charged. As a result, if you are trying to submit only one request to be processed, please do not fax repeated times. F a x completed form to ( 3 1 7 ) 2 7 8 - 2 2 4 0  . Ma i l form to IUPUI Office of the Registrar Campus Center, Suite 250 - 420 UniversityBoulevard Indianapolis, Indiana 46202-5144 

Student Information 

Last Name: First Name: Middle: 

Name used while attending (if different): 

Ten DigitUniversity ID: and/or 

Last 4 digitsof SSN:

Date of Birth (mm/dd/yyyy): 

Email:

Street Address:

Phone#:  Years attended:From:  To:

(yyyy) (yyyy)

City: State: Zip: Country:

Exceptions: 

Unless specified otherwise, we will immediately issue an Official Indiana University Transcript including all completed coursework at all

IU campuses.

Exceptions: Graduate course work only Law only Dentistry only Medical Students (click here) 

Hold for current semester grades

Hold for grade change in - course #: (i.e. math-a 111) Semester: year(yyyy): 

Hold for degree - Degree (i.e. BA/BS): Date expected(mm/yyyy):

Send PDF Transcript To: (recipient name and email address are required for PDF delivery option ($10 per recipient)) 

Name:

Email:

Confirm 

Email:

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Signature and Printing Instructions - This form must be completed, printed, signed and sent with payment to the Registrar's Office by fax or mail.

Student Signature: Date(mm/dd/yyyy):

Payment Information - Use the Delivery Options and Fees grid to assist calculating charges (click here)

Number of PDF transcripts requested: X $10.00 = Total: $ 

My check is enclosed and made payable to IUPUI

I want to pay by Credit Card: Visa  Master Card Discover Card American Express JCB Card

Card #: Expiration date(mm/yyyy):