EVMS Office for Student Affairs: Request for Transcript

Request for Transcript of Record

Please complete one request for each designate to receive a transcript. Copies sent to the requester will be stamped Issued to Student. Allow 10 days for processing. No transcripts will be released until an official transcript request is received bearing the requestor's signature and all financial and other obligations to the institution have been met.

PLEASE NOTE - This form may be filled out online, but must be printed and forwarded to the address below; an original signature is required for release of information (a fax copy is acceptable).

Student Information

First Name		Middle Name
Last Name		Maiden Name
Email Address		Social Security Number
Last Date of Attendance		Class Year
Program		Date Ordered

Recipient Information

Provide in the block below the name and address of the individual or institution to receive the transcript. This will be the mailing label.

Requestor Information

Signature: _____________________________ Date: ________________

Mailing Address:

Print and Mail

Eastern Virginia Medical School
Office of the Registrar, Lewis Hall, Room 1169
P.O. Box 1980
Norfolk, VA 23501

Fax: (757) 446-5817

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