Web Transcript Request

Please print this transcript request form, complete, and mail or fax it to us.

Please mail request with the $4 fee per transcript to:
Office of the Registrar
Campus Box 145
Knox College
2 East South Street
Galesburg, IL 61401

You can also fax your  request with a billing address to: 
(309) 341-7601

PERSONAL INFORMATION AND BILLING ADDRESS

Student ID Number (if known):  _____________      Phone Number: (_____ )______- _______

Student Name (Please Print): __________________________________________________________

Street: ____________________________________________________

City:   ____________________________________   State:___________    

Zip: ____________  

Country:_________

Last Year Attended:  _________________________

PURPOSE OF TRANSCRIPT

Please check:

______  Grad School (field: _________________________ )            

______  Medical School, Dental School

 ______ Fellowship, Scholarship                                                 

______  Transfer

 ______ Off-Campus Study (Program: __________________ )            

______  Military Service

______  Peace Corps                                                                    

______  Teaching Certificate

______  Job Application                                                                

______  Other

SEND TRANSCRIPTS TO...

Please send my transcript(s) to the following addresses:

1) _____________________________________________________     

Number of Copies: ______

_______________________________________________________

_______________________________________________________

_______________________________________________________

2)  _____________________________________________________     

Number of Copies: ______

_______________________________________________________

_______________________________________________________

_______________________________________________________

 3)  ____________________________________________________     

Number of Copies: ______

_______________________________________________________

_______________________________________________________

_______________________________________________________
      

AUTHORIZATION

I authorize Knox College to release my Knox College Transcript to the parties named on this form.

SIGNATURE:  _______________________________________________________     

Date: ___________________