Get Antioch University Midwest Transcript Request Form

Signature for release required Date of request Submit completed request with check money order payable to Antioch University or credit card information to Registrar s Office Antioch University Midwest 900 Dayton Street Yellow Springs Ohio 45387. Credit card users may fax this completed form to 937-769-1804 Number of transcript copies via USPS mail X 5. Teacher Licensure Master of Education Ohio Principal Licensure ELSS Sum. Inst. For Teachers George Meany Institute Your full name as shown in our records Daytime telephone number should we have processing questions Your address City State Zip Your SSN - - Dates attended required SEND TRANSCRIPT S TO Providing a specific name or office will assist in prompt delivery Include narratives Yes No Under the provisions of the Family Education Rights and Privacy Act of 1974 I authorize the Registrar to release a transcript s of my academic record to the individual s and/or organizations stated on this request. Signature for release required Date of request Submit completed request with check money order payable to Antioch University or credit card information to Registrar s Office Antioch University Midwest 900 Dayton Street Yellow Springs Ohio 45387. Office of the Registrar 900 Dayton Street Yellow Springs OH 45387 937-769-1665 midwest. antioch. edu Transcript Request Form Check all Programs Attended Undergraduate Studies Grad Management IMA / ILPS Conflict Analysis Engagement Intercultural Relations Community College Mgt. Teacher Licensure Master of Education Ohio Principal Licensure ELSS Sum* Inst* For Teachers George Meany Institute Your full name as shown in our records Daytime telephone number should we have processing questions Your address City State Zip Your SSN - - Dates attended required SEND TRANSCRIPT S TO Providing a specific name or office will assist in prompt delivery Include narratives Yes No Under the provisions of the Family Education Rights and Privacy Act of 1974 I authorize the Registrar to release a transcript s of my academic record to the individual s and/or organizations stated on this request. Signature for release required Date of request Submit completed request with check money order payable to Antioch University or credit card information to Registrar s Office Antioch University Midwest 900 Dayton Street Yellow Springs Ohio 45387. Credit card users may fax this completed form to 937-769-1804 Number of transcript copies via USPS mail X 5. 00/ea Please overnight via UPS Same day service in person Total enclosed Or circle one charge to VISA MASTERCARD DISCOVER Card Number Expires Exact Name on CardCV code Registrar Office Rev 8/26/10 Office Use - Processed Yes No By Date. Office of the Registrar 900 Dayton Street Yellow Springs OH 45387 937-769-1665 midwest. antioch. edu Transcript Request Form Check all Programs Attended Undergraduate Studies Grad Management IMA / ILPS Conflict Analysis Engagement Intercultural Relations Community College Mgt. Teacher Licensure Master of Education Ohio Principal Licensure ELSS Sum* Inst* For Teachers George Meany Institute Your full name as shown in our records Daytime telephone number should we have processing questions Your address City State Zip Your SSN - - Dates attended required SEND TRANSCRIPT S TO Providing a specific name or office will assist in prompt delivery Include narratives Yes No Under the provisions of the Family Education Rights and Privacy Act of 1974 I authorize the Registrar to release a transcript s of my academic record to the individual s and/or organizations stated on this request.