TRANSCRIPT REQUEST 
Please print

SSN_________________________________________Date___________________________ 

Name_______________________________________________________________________ 

Street Address________________________________________________________________ 

City____________________________________________________State/Zip_____________ 

Student's Signature_______________________________________Phone________________ 

___ Send transcripts immediately. 

___ Wait until: __Grades have been processed for __ Fall __Winter __ Spring/Summer 
                                                                             __ Block I __ Block 2 __ Block 3 

__ Degree has been posted 

Number of transcripts requested___________________________________________________ 

COMPLETE ADDRESS IS NEEDED WITHIN BOX BELOW (complete one box per addressee) 
SEND TRANSCRIPT TO:
 
Office of Career Services 
Governors state University 
University Drive 
University Park,IL 60466 
 
 
 
 
 
 
 
 
 
 
 
Effective June 17, 2002, a fee of $5.00 per transcript is required and payable by check or money order to Governors State University. Payment must accompany each request. Credit card payments are not accepted at this time. Faxed or e-mail requests cannot be accepted.