Request for Transcript of Academic Record

Complete this form, print, sign, attach check or money order, deliver to:
Office of Registrar
PO Box 108
Hanover, IN 47243
Phone 812-866-7051
FAX 812-866-7054

Student's Name
(as it is listed in our system or on your diploma)

Social Security Number:
Date of this request: Number of copies
Dates of Attendance: From To
Date to send/Pick up Transcript

Student's Signature ___________________________ Date ______________

Current Student Unit Number Phone:

Alumni Address
 
City, State, Zip
Phone Number

For each transcript requested, there is a fee of $3.50. Any student whose college account is encumbered at the time of processing this form, will not be issued a transcript.
*** Make checks payable to: Hanover College. ***

Mail Transcript to:
Name:
Address:
 
City, State, Zip:
Express Mail (Additional Charges, Please Contact Registrar's Office)

Other information to include on face of envelope. (i.e. Attention:, Country Other than USA, Graduate School, etc.)

We Accept Visa / Mastercard
Type of Card
Card Holder Name
Credit Card #
Expiration Date
Address
Zip Code
V-Code (3 Digit)
This is on the back of the Credit Card on the Signature
Amount $3.50 per

For Office Use: Amt. Paid ________ Rec'd by: ______

Date Transcript Sent: ______________