TRANSCRIPT 
REQUEST
FORM

 links to UW-La Crosse Homepage
Records & Registration

UW-L charges a  $10.00  fee for each set of transcripts (undergraduate and graduate records together are considered one set). Failure to complete this entire form may result in a delay in the issuance of your transcript.

 No request from a third party will be accepted.  Multiple copies to student will be in separate sealed envelopes unless directed otherwise - use Special Instructions section below. 

Due to the Family Rights and Privacy Act of 1974, your signature is required for the release of a transcript. 

Note:  All transcripts sent to the students are stamped "issued to student".  Not all institutions (colleges, employers, scholarship funds, etc) will accept these transcripts even if they are in sealed envelopes.  It is up to the student to verify with the  receiving institution if transcripts need to be sent directly from UW-L to them.  Many institutions require transcripts  be sent directly from UW-L to their institution to be considered official.

                      How to use this form

                      1. FILL-OUT FORM
                      2. P R I N T
                      3. S I G N
                     4. ENCLOSE CHECK
                              (payable to UW-La Crosse)
                     5. M A I L 

with check for  $10.00  per set of transcripts to

Records & Registration
Attn: Transcripts
UW-La Crosse
1725 State Street
La Crosse, WI 54601

Last Name:  First Name:  Initial:  

Date of Birth:   (mm/dd/yyyy)                     ID Number:  or Social Security number.

Former Name(s): (List ALL) 

 Daytime Phone:  List area code first.

Current Address: 

City:  State:  Zip Code: 

Email:  Copies: 

When to Send:   Status: 

First Term Enrolled:   Year:   Last Term Enrolled:   Year: 

I hereby give consent to have my transcript released to the recipient(s) listed below.

Signature

Recipient(s)  Name and Address:



Recipient(s)  Name and Address:



Transcripts will be withheld if any obligations to the university have NOT been satisfied.