Transcript Request - Private Florida Research …

1 Transcript Request NOVA SOUTHEASTERN UNIVERSITY. Enrollment and Student Services Office of the University Registrar DATE OF Request _____ / _____ / _____. 3301 College Avenue Fort Lauderdale, Florida 33314-7796. (954) 262-7200 800-541-6682 Fax (954) 262-4862. Please print clearly. Nondegree Program Major _____. You must complete all information requested. Undergraduate Program Major _____. C. harge is $10 per Transcript . Exact payment must accompany each Request unless the Transcript is for NSU internal use. Master's Program Major _____. F. or multiple requests, complete a Transcript Request form and Ed. Specialist Program Major _____. attach a list containing the name and mailing address for Law Program Major _____. each addressee.

2 Doctoral Program Major _____. Fees are subject to change without notice. Health Professions Program Major _____. T. ranscript will not be released with any existing hold(s). on record. Dates of Enrollment _____to_____. T. ranscript will not be released until all accounts are paid in full. Student is responsible for correct mailing address Special instructions printed below. Any address correction charges incurred by I will pick up the Transcript . Transcript will be stamped: the university will be charged back to the student. Official Transcript issued to student. Include dates of enrollment in the space provided. Notify me at ( _____ )_ _____. Y. ou can either mail this form to the above address or fax Hold for degree conferral _ _____.

3 It to (954) 262-4862. Degree Anticipated Conferral Date Miami-Dade County Schools only Hold for grade change _ _____. Course Correct Grade Include tuition reimbursement/FT 1 form for _____ term. Mail Transcript Other _ _____. Print name and address clearly Internal Transcript (NSU Program_____ ). _____ Domestic Express Overnight Delivery (no Box address). Present Name ($9 plus $10 per Transcript ). _____ International Express Delivery (no Box address). Name used at Nova Southeastern University ($24 plus $10 per Transcript ). _____. Address Method of payment _____. City State ZIP Cash (only accepted at One-Stop Shop). _____ Credit Card Check or money order payable to NSU. NSU ID/SSN. No charge ( Transcript for NSU internal use only.)

4 _____. Telephone Email Address I hereby authorize a charge to be made to my credit card Please do not use the contact information to update my student record. VISA MasterCard American Express (If name is different, it will not be updated). _____. Mail Transcript to (If internal, indicate NSU program.) Account Number _____ _____ _____. Expiration Date Amount Name _____ _____. Check/Money Order Number 1st Street Address _____ _____. Signature (required) Date 2nd Street Address _____. City State ZIP. _____ FOR OFFICE USE ONLY. Number of Copies NSU Program Transcript fee 2120. _____ Amount due $ _____ Please remit $_____. Signature (required). Amount rec. $ _____ By_____. Social Security Number to be printed on the Transcript Credit $_____.

5 Print a masked SSN (ex. XXX-XX-1234) Date issued _____ By_____. Print full SSN Hold reason_ _____. Transcript Request Form, REV. 3/18 02-000-14 DBB.