Concordia University, St. Paul: Transcript Release Form

APPLICANTS: Please send your signed and completed form via fax to 1-270-387-1738 or email to

transcripts@csp.edu

Please note: Some institutions may require you to obtain your official transcripts directly; if this is the case, your enrollment counselor will

contact you.

If you attended additional schools, please use additional copies of this form

Concordia University, St. Paul: Transcript Release Form

Notice to Institution Records Office: This is a request for official transcripts on behalf of a former

student of your institution. Information needed to process this request can be found below.

Please return official transcript materials to:

Concordia University, St. Paul

C/O Wiley Education Services

851 Trafalgar Court, Suite 420 West

Maitland, FL 32751

Or email using a secure service to [email protected]

If you cannot process this request, please contact the Transcript Office at 502-719-6417

APPLICANTS PLEASE COMPLETE ALL INFORMATION BELOW:

1. Previously Attended Institution: ____________________________________________________

Mailing Address: ____________________________________ _________ ______________________________

City State Zip

Dates Attended from: ________ to: _______ Program Seeking/of study: ___________________

Student ID Number: ________________________ Degree(s) Earned: _______________________________

2. Previously Attended Institution: ___________________________________________________________

Mailing Address: ____________________________________ _________ ______________________________

City State Zip

Dates Attended from: ________ to: _______ Program Seeking/of study: ___________________

Student ID Number: ________________________ Degree(s) Earned: _______________________________

3.Previously Attended Institution: _____________________________________________________________

Mailing Address: ____________________________________ _________ ______________________________

City State Zip

Dates Attended from: ________ to: _______ Program Seeking/of study: ___________________

Student ID Number: ________________________ Degree(s) Earned: _______________________________

TRANSCRIPT RELEASE AUTHORIZATION

I authorize my official transcripts to be sent to Concordia University, St. Paul C/O Wiley Education Services

and allow any necessary follow-up, including the release of non-directory information, to acquire official

transcripts from each of the institutions listed below.

Signature: ____________________________________Date:_______________

Legal Name: ________________________ _________________________ ______________________ ___________________

First Middle Last Former Name(s)

Permanent Address: _________________________________________ __________________________ ______ __________

Street City State Zip

Date of Birth: ______ - ______ - ______ Social Security Number __________- _____ - _________

Phone ________________________________________ Email _______________________________________________