Georgia State University - A Leading Research University located in Atlanta, GA

Transcript Request Form


Office of Undergraduate Admissions
P.O. Box 4009,
Atlanta, Georgia 30302-4009


Note to Applicant: Send a copy of this form to every institution you have attended.


Applicant's name (last/family name, first, middle)
_________________________________________________________________________

U.S. Social Security or Student ID Number __ __ __ - __ __ - __ __ __ __

Date of Birth _______________

Address: (street address and, if applicable, apartment number)
_________________________________________________________________________

City _________________________ State ____________________ ZIP Code ___________

Name of Institution _________________________________________________________

When did you last attend? ____________________________________________________

I hereby authorize release of my transcript to Georgia State University. Please send to the Office of Undergraduate Admissions, P.O. Box 4009, Atlanta, Georgia 30302-4009.

Applicant's signature ___________________________________ Date __________________