Request for Official Transcript Clark University
Registrar’s Office 950 Main Street Worcester, MA 01610-1477

FAX# 508.793.7548

Date of Request _________________________ (Allow three days to process request)

Student ID or SSN::

Last Name, First, Middle:

Local Address:

Email Address:

Day time telephone number:

Send Transcript To:

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Transcripts are not released to students who have an outstanding financial obligation to the University. Transcripts can only be released with your written permission granted by your signature below.

Your Signature: ______________________________________________________________________

Fee: $4 per copy (for each official or faxed unofficial transcript) = Total Due: ___________

Fee: $1 per copy (for each unofficial transcript) = Total Due: ____________

Payment in full must accompany this form. Please make checks payable to Clark University.

Credit card users may FAX a completed form (see number above)

Visa/Mastercard/Discover (card number, name on card and expiration date):

Please check all that apply:

___Undergraduate ___ Graduate ___ Special (non-matriculant) ___ Currently Enrolled ___ Degree Received

Last year in attendance: _________ Name while at Clark (if different): ___________________________

Hold for pick up _______ Hold for semester grades _______ Hold for degree posting ________________