TRANSCRIPT REQUEST FORM

                                                                                                            Updated:  7/30/10

Print this form - complete entire form

Send to:     Registrar, Sacred Heart School of Theology,

                   7335 S Hwy 100, P.O. Box429, Hales Corners, WI 53130-0429

Fax to:     Registrar (414-529-6999)

 

NAME:_____________________________________________________________

 

SHST ID# or SS#:_____________________________________________________

 

TELEPHONE: Day_______________________ Evening ______________________

 

EMAIL: ญ____________________________________________________________

 

CURRENT ADDRESS: _________________________________________________

 

___________________________________________________________________

 

___________________________________________________________________

 

___________________________________________________________________

 

 

 

SIGNATURE: ________________________________________________________

 

DATE: _____________________________________________________________

 

If you were enrolled under any other name (maiden, religious, etc.) or have a name change,

please indicate other name below. 

 

___________________________________________________________________________

 

Attended from ___________________ญญญญ_ to _________________________________

 

Degree/Year:  MDiv __________ MA _________ Certificate _________ Other___________

 

Send Transcripts to:  (Name, Address, City, State, Zip required)

(Official transcripts are sent directly to another institution or place of employment only)

(Student copies are not considered official)

 

________________________________________          _______________________________________

 

________________________________________          _______________________________________

 

________________________________________          _______________________________________

 

________________________________________          _______________________________________

 

If additional addresses are to be included, please use the back of this form.

FEES:  

-                $5 each for regular service.

-                $25 each for rush service (processed upon arrival).

-                $50 each for outside the U.S.A.

 

 

Total Due:

         # of Transcripts requested ___________  X  Fee $__________  =  $___________

 

 

         Payment in the form of: 

                     ___ Check enclosed    Check amount $__________     Check # __________

 

                     ___ Credit Card:          ___MasterCard            ___Visa         

 

                                                         Card # ________/__________/__________/__________

 

                                                         Exp. Date  _________/__________    Security Code ______

                                                        

           Name on Card (please print)________________________________________________

                                                        

            Signature  ______________________________________________ญญ________________