Academic Transcript Request Form

Academic Transcript Request Application Form

“In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, transcripts are issued only at the formal written request of the student, former student, or alumnus. This requires the signed release of the student using either the electronic request system or the transcript request form.”

Excelsior Healthcare Academy now offers an online transcript ordering.  Delivery options include mail, express, and international shipping, and secure electronic delivery.
The base price per transcript is $10; some delivery options and multiple requests may include additional charges.

Click here to pay for the processing fee and return to this page to complete your request form.

Academic Transcript Processing Fee

Academic Transcript Application Form

Please arrange to pay the required $10 fee per transcript. Transcripts will be processed after both the form and the payment have been received. If payment is not received within 30 days of receipt of this form, the form will no longer be valid.

Request A Transcript Form

Name *

First

Last *

Last

Email *

Phone *

Website/URL

Program of Study *

Last 4 digits of Social Security Number *

Program Start Date *

Program End Date *

Correspondence Address *

Correspondence Address

City

State/Province

Zip/Postal

Country

Transcript Recipient

where do you want the transcript sent to?

Checkboxes *

My Correspondence Address

Other Institution(s)

Check as applicable. Please arrange to pay the required $10 fee per transcript. Transcripts will be processed after both the form and the payment have been received.

Institution Address (1)

City

State/Province

Zip/Postal

Country

Institution Address (2)

City

State/Province

Zip/Postal

Country

Upload your Processing Fee receipt

Maximum file size: 268.44MB

Product

Request Processing Fee

Expedited Delivery

Optional if you already have an invoice

By submitting this application, I consent to the release of my academic transcript. *I hereby authorize Excelsior Healthcare Academy to release my transcripts according to the above selection.

Signature *

Type in your full name

Date

Cart

Cart

Academic Transcript Request Application Form

Academic Transcript Application Form

Please arrange to pay the required $10 fee per transcript. Transcripts will be processed after both the form and the payment have been received. If payment is not received within 30 days of receipt of this form, the form will no longer be valid.

Transcript Recipient