Keep for Future Reference – Copy Appropriate Request Form and Use to Order Transcripts
The Family Educational Rights and Privacy Act of 1974 (FERPA) requires that all transcript requests be in writing, signed and dated by the person to whom the record belongs. Telephone, faxed, scanned and email requests WILL NOT be accepted. You can assist us in giving speedy accurate service by providing complete information.
To obtain a transcript, send a written request that includes the following:
After completing request in its entirety, send it to the above address
There is a $5.00 processing fee for all official transcripts (current students may receive 1 free official transcript per semester). There is no fee for unofficial transcripts. Official transcript fee payment will accepted in the form of check, money order or cash. Checks should be made payable to PA College.
We are unable to fax transcripts, official or unofficial.
Please Note: College policy prohibits issuing transcripts to any student who is indebted to the College. The issuance of partial transcripts is strictly prohibited.
PENNSYLVANIA COLLEGE OF HEALTH SCIENCES
Office of the Registrar
410 N. Lime Street
Lancaster, Pennsylvania 17602
TRANSCRIPT REQUEST FORM
PLEASE PRINT CLEARLY
Incomplete information may result in processing delays
No partial transcripts issued. College policy prohibits issuing transcript(s) to any student indebted to the College. Transcripts will not be released to/for anyone except the student, unless appropriately requested in writing by the student.
Student Colleague ID or SSN: ______________________________ Date of Birth: _______________________ Name: __________________________________
Current Last First Middle Any other name(s) used
Current Mailing Address: Street: ______________________________________________________________
PO Box/Apt #: _________City: _________________________ State: _________ Zip: ____________
TYPE OF TRANSCRIPT REQUESTED: [ ] OFFICIAL ($5 each) [ ] UNOFFICIAL
COURSE OF STUDY:
[ ] CARDIAC ELECTROPHYSIOLOGY [ ] NUCLEAR MEDICINE TECHNOLOGY
[ ] CARDIOVASCULAR INVASIVE SPECIALTY [ ] NURSING
[ ] DIAGNOSTIC MEDICAL SONOGRAPHY [ ] RADIOGRAPHY
[ ] GENERAL EDUCATION [ ] RESPIRATORY CARE
[ ] MEDICAL LABORATORY SCIENCE [ ] SURGICAL TECHNOLOGY
[ ] BSN [ ] BSHS [ ] BSHA [ ] EMT [ ] PARAMEDIC
CHECK ONE: [ ] CURRENT STUDENT
[ ] ALUMNI Year of Graduation
[ ] WITHDRAWN STUDENT Dates of Attendance to SEND TRANSCRIPTS TO: (For multiple requests, please use back of form). Applicant is responsible for current mailing address.
Complete Name of Institution: Name of Person/Office:
Street City State Zip Code
[ ] Check if transcript is to be mailed to student’s home address.