Transcript Request Form

Student Services

Please

read before completing

- Student records are strictly confidential

and transcripts are issued only upon the

written consent and signature of the

student.

- Request form must be completed in full.

- Lifetime transcript fee is included in full

time compulsory fees introduced in 2006 /

7. If you were full-time before 2006 / 7 or a

part-time student you must select and pay

with one of the payment options.

- If you have outstanding fees, your transcript

will not be issued until resolved.

- Course outlines and descriptions are not

included with your transcripts. You must

contact your academic school directly.

- Transcripts from high schools or other

post-secondary institutions which have

been sent to St. Lawrence College cannot be

copied or released.

- Unofficial transcripts are provided at no

cost, they are not stamped or sealed.

- Official transcripts cannot be faxed or

emailed

-Transcripts cannot be sent by courier to P

Boxes

Student Information

________________________ ______________________ _________

Last Name First Name Initial

________ ______________________________________ __________________

Apt. No. Street Number & Name City

_______/____________ __________________ __________________

Province/Country Postal Code Telephone #

____________________________________________

E-mail

Program Information

Program(s) Attended: ________________________________ Most recent Year:________

Print form & Sign Confidentiality Agreement below to process

St. Lawrence College maintains compliance with all privacy requirements, including FIPPAA and Bill C-6, the Canadian Federal Privacy Legislation, and the

Personal Information Protection and Electronic Documents Act (PIPEDA). The Privacy Commissioner of Ontario can be reached at 1800-387-0037.

Signature (REQUIRED for processing - no electronic signatures) Date

Office Use Only

Date

Initials

Received

Mailed

Picked Up

Emailed

SLC Student #(if known): _____________________

Date of Birth: ______ ______ _______

DD MM YYYY

Transcripts Information (please fill out When, Delivery Instructions and Quantity of each below)

When do you want us to send your transcript(s):

Send Now (mailed within 10 working days)

Send after Semester (choose): Fall (Sent Jan)

Winter (Sent May)

Spring (Sent Sept)

Send after Graduate Credential is posted (typically June)

Delivery Instructions (check all that apply)

Unofficial:______

All official transcripts issued directly to students will be stamped as such

Payment options

*Full Time students after 2007 have paid the lifetime fee in their tuition – if you have already paid, a new charge will not occur

$10 for 1 transcript only

$20 for 2 or more transcripts. Lifetime fee will be applied to your account (pay only once)

Lifetime fee paid previously (If fee has not been paid request will not be processed)

Lifetime Term

Want to Courier your transcript(s)? $25 per destination

Choose which transcript(s) to courier (US/Can only):

Method of Payment: Cash Cheque Interac Credit Card:

____________/____________/____________/____________

______/______

Credit Card # (American Express, MasterCard or Visa)

Expiry (mm/yy)

__________________________________________ $_______________ ___________

Signature of Cardholder(if different then below) Total Amt Authorized Date

Last name while attending: ___________________________________________________

Please send completed form to one of

the following:

BROCKVILLE CAMPUS – STUDENT SERVICES

2288 Parkedale Ave

Brockville, Ontario K6V 5X3

(613) 345-0660 ext 3154

Fax (613) 345-7871

Transcript[email protected]

CORNWALL CAMPUS – STUDENT SERVICES

2 St. Lawrence Drive

Cornwall, Ontario K6H 4Z1

(613) 933-6080 ext 2702

Fax (613) 937-1524

Transcript[email protected]

KINGSTON CAMPUS – STUDENT SERVICES

100 Portsmouth Avenue

Kingston, Ontario K7L 5A6

(613) 544-5400 ext 5505

Fax (613) 545-3923

Transcript[email protected]

)beloe)

__________

3-digit CVV security code

Please email my Unofficial transcript to:___________________________________________

Please mail my Official transcript to the home address listed above - # to send ______

I will pick up my official transcript (proper photo ID required) - # to pick up ______

Please mail to recipient below:

Recipient 1:______________________________

Reference #/Name ________________________

City/Prov: _____________________/_________

Postal Code: ____________ # to send: _______

Recipient 2:_______________________________

Reference #/Name _________________________

Address: _________________________________

_________________________________________

City/Prov: _____________________/__________

# to send: _______

Home Recipient 1 Recipient 2

Postal Code: ___________

Address: ________________________________

________________________________________