CalSouthern Official Transcript Request Form Accounting@CalSouthern.edu | T: 800.477.2254 | F: 714.263.8373 600 Anton Blvd S u i t e 1 1 0 0 C o s t a M e s a C A 9 2 6 2 6
ALLOW FOR 5-7 DAYS FOR PROCESSING Important conditions to be aware of when requesting transcripts: • All transcript requests must be approved by accounting before your transcript will be released. • Please remit payment to the accounting office by Contacting the Accounting Department: Accounting@CalSouthern.edu, Phone: (800) 477-2254 ext. 4246
LEARNER INFORMATION REQUIRED CalSouthern ID# *ID Unknown- Leave Blank
Current CalSouthern Status: Check One Date of Birth (mm/dd/yyyy) Current Student Alumni Telephone Number
(Intl. include country code)
NAME Last
First
Middle
FORMER NAME Complete only if name has changed since enrollment Last
First
Middle
LEARNER MAILING ADDRESS Number
Street
City
Apt/Unit # State
Zip Code
Country
Completing and e-signing this request for transcripts authorizes the release of records as indicated on this form and to the consent for the authorized recipient to receive requestor’s academic transcripts. This request of transcripts does not authorize additional academic information to be provided to any party beyond the verified transcript. *REQUESTOR SIGNATURE: *DATE:
NUMBER OF COPIES: ______ PROCESS OPTIONS: *Check One Now After Current Grades Post After Degree Conferred
Transcript Fee: $10.00/Each Payable to California Southern University by Check or Credit/Debit Card RECIPIENT INFORMATION MAILING TRANSCRIPTS TO: Same mailing address as above check here and skip to payment section Attention to:
Name/Organization:
Number
Street
City
Apt/Unit # State
Zip Code
Country
PAYMENT INFORMATION If graduated, enter your payment information below. Active learners must use Self-Service to pay for the Transcript Fee(s).
CREDIT/DEBIT CARD AUTHORIZATION: Charge my credit card $10 per transcript copy VISA Master Card American Express Discover Name on Card:
Card Number:
Exp Date:
Completing this section and signing below authorizes the accounting department to process payment for this transcript request using the provided card information above. *AUTHORIZING SIGNATURE: *DATE OF AUTHORIZATION:
CALSOUTHERN OFFICIAL USE ONLY Accounting Authorization of Release:
#Transcript Units Approved:
FORM: Registrar and Records Office VERSION: 0 1 2 2 2 0 2 0 C a l S o u t h e r n . e d u | T : 8 0 0 . 4 7 7 . 2 2 5 4 | F : 7 1 4 . 4 8 0 . 0 8 3 4 |6 0 0 A n t o n B l v d S u i t e 1 1 0 0 ,
Costa Mesa, CA 92626