BusinessOffice Use Only: Criminal Justice Institute TRANSCRIPTREQUESTFORM THIS FORMIS ONLYTO BEUSEDIF PAYINGTHETRANSCRIPTFEE(S) WITH CASH,DEBIT, CHECKORMONEYORDER. Pleasemake check or money order payable to: Valencia College
PLEASE NOTE - Transcripts will not be released if: 1. There is a hold on your student record. 2. There is a pending balance with the Finance Office or the Library. 3. The non-refundable transcript fee of $3.00 per transcript has not been paid. __________________________________________________ Student Valencia ID/Social Security Number
Last Name (At the time your attendance)
First Name
□ Holds Cleared □ Transcript FeesPaid Receipt # AddressChange: Y or N Employee Initials EC OC WC WP
________________________________ Date
Middle Name
Birth Date
Street Address
City
State
Zip
( ) Telephone
Can we use this to update your address?___Yes___No When do you want your transcript(s) processed?(Pleasecheck one)
□Within 24 Hours □Hold for Final Grades □Hold for Degree to be Posted Transcript You must sign this form before your request may be processed. Type of Transcript Needed: Academy_____ Credit ______ Total Number of Transcripts
Student Signature
Pleaseprint clearly, in the space below, the complete name and addressof where you want your transcript(s) sent. Fill out a separate request forms for each addressto which you are sending transcripts. MAILINGADDRESSFORTRANSCRIPTS(S) Institution Name: Contact./Dept. Name: Address: City, State & Zip: This form can be turn in to the Criminal Justice Institute or mailed to: Attn: Technical Document Specialist Valencia College Criminal Justice Institute 8600 Valencia College Lane Orlando, FL. 32825