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For UC San Diego cam us lease pro ide n o p a p p v depart ent and mail code. q Fax now 5 additional charge 10 international Address 1 ADDRESS 2 q FedEx transcript fee rush fee 15 FedEx fee Transcript fee 15 per copy Total Fees Enclosed Total Cop ies Requested q Pick-up Specify location Check if appli able c q Was this an edu a ion class ffered hrough a c t t school dis trict or edu ca tion cen ter q Did you take UC San Diego Exten ion cours es before 9/15/67 Payment method Check One q Cash/Check q Visa q Mas er ard t C Pay ble to UC Regents q Dis ov r c e q American Express q Diners Club For Office Use Only Exp. Date / Total Fees Paid Account No. Author iz ing Sig na ture Date Received Signing the above request releases UC San Diego Extension from any liability for faxed transcripts. q Purchase Order Must Be Attached q Visa q Mastercard q Discover q AmEx q Diners Acct. No. Employer Name Division/Department Phone 1213-5024 extension.ucsd. Transcript Request Please type or print clearly. Unofficial 5 Stu dent ID s sub mit ted in writ ing Mail to Last Name First Name Initial Street Address Student Services Uni ver sity of Cal i for nia San Diego Exten sion 9500 Gil an Dr. Dept. 0176-H m La Jolla CA 92093-0176 Fax Num er 858 534-8527 b City State Zip Phone Numbers Phone Num er Alternate Phone Number 858 534-3400 La Jolla 619 260-3070 Mission Valley 858 534-9999 University City Center Email Address Check one q Send now Your Sig na ture q Hold for cur ent quar er rades r t g Mail tran cripts to q Rush 20 additional charge one business day service Tran cripts can ot be mailed with ut the com lete ddress. For UC San Diego cam us lease pro ide n o p a p p v depart ent and mail code. q Fax now 5 additional charge 10 international Address 1 ADDRESS 2 q FedEx transcript fee rush fee 15 FedEx fee Transcript fee 15 per copy Total Fees Enclosed Total Cop ies Requested q Pick-up Specify location Check if appli able c q Was this an edu a ion class ffered hrough a c t t school dis trict or edu ca tion cen ter q Did you take UC San Diego Exten ion cours es before 9/15/67 Payment method Check One q Cash/Check q Visa q Mas er ard t C Pay ble to UC Regents q Dis ov r c e q American Express q Diners Club For Office Use Only Exp* Date / Total Fees Paid Account No* Author iz ing Sig na ture Date Received Signing the above request releases UC San Diego Extension from any liability for faxed transcripts. q Purchase Order Must Be Attached q Visa q Mastercard q Discover q AmEx q Diners Acct* No* Employer Name Division/Department Phone 1213-5024 extension*ucsd. Transcript Request Please type or print clearly. Unofficial 5 Stu dent ID s sub mit ted in writ ing Mail to Last Name First Name Initial Street Address Student Services Uni ver sity of Cal i for nia San Diego Exten sion 9500 Gil an Dr. Dept. 0176-H m La Jolla CA 92093-0176 Fax Num er 858 534-8527 b City State Zip Phone Numbers Phone Num er Alternate Phone Number 858 534-3400 La Jolla 619 260-3070 Mission Valley 858 534-9999 University City Center Email Address Check one q Send now Your Sig na ture q Hold for cur ent quar er rades r t g Mail tran cripts to q Rush 20 additional charge one business day service Tran cripts can ot be mailed with ut the com lete ddress.