To Registrar:__________________________________________________________________________

Institution Attended

        City                                                                                                  State                                                             Zip

Please send a copy of my official transcript of academic record at your institution to:

The University of Alabama in Huntsville

Office of Admissions

University Center Room 124

Huntsville, Alabama 35899

I attended your institution from ____________________________ to _____________________________ and

My record will be filed under the name: _________________________________________________________

My Social Security number is ___________________     My Date of Birth is ___________________________

My present name is _________________________________________________________________________

I reside at _________________________________________________________________________________

Street, P.O. Box, Rural Route

               ________________________________________________________________(____)____________

                    City                                                                     State                                 Zip                             Area Code Telephone

                _________________________________________ ____________________________

                                    Signature                                                                                             Date

TO THE STUDENT REQUESTING THE TRANSCRIPT: Most institutions require the payment of a fee before issuing transcripts. You may save time by including your payment with this request. If you have married or changed your name since attending this institution, please give the name in which your record will appear. UAH will accept official transcripts hand-carried if in an unbroken sealed envelope from the institution.

An Affirmative Action/Equal Opportunity Institution