Kansas State University Transcript Request Form
(Note: Click here for important information concerning requesting a transcript)

Complete all eight items and return to one of the above addresses. Please print legibly.

1. Name ______________________________________________________________________________
        Last, First, Middle                                         Maiden or other   

   Social Security or Student ID Number ______________________________________________
  
   Birthdate: _________________________
  
   Daytime Telephone Number ______________________ E-Mail Address ____________________
								
2. Address _______________________________________________________
           Number & Street

           ___________________________   ________  _______________
	   City	                                 State	    Zip

3. Check if you are currently enrolled [  ]
   OR indicate approximate dates of attendance ___________________
                    					       Semester/Year
4. Number of transcripts to be mailed to address below_______(click for transcript cost)								
   A transcript request will not be processed for a student who is delinquent to the university. 								
   Note: Pickups and sendouts must be ordered on separate forms. If transcript is to be sent to            
          more than one address, use additional forms.
						
   Name __________________________________________________________ 
    	        
   Street ________________________________________________________           

   City ____________________  State ________  Zip ________________
   Note: Student is responsible for correct address. Transcript(s) will be mailed to the address            
          indicated above.

5. Number of transcripts to be faxed to fax number below _________
   FAX # ____________________________ (click for FAX cost)
         (Area code) Note: Fill in only if fax is to be sent.
   Send FAX attention: ________________________________________________	

6. (Check one)
   [  ] Pick up now
   [  ] Send now, do NOT hold for semester grades
   [  ] Hold until semester grades are posted (circle semester: Spring or Fall)
   [  ] Hold until degree statement is posted
   Other instructions: ____________________________________________

7. Method of Payment: Cash [  ]     Check [  ]
   American Express / Discover / MasterCard / Visa (Manhattan Campus Only)
    (circle one)
    Credit Card # ________________________________  Exp. Date ______________

8. Student's signature _________________________________  Date _____________