Electronic Transcript Order Form

Please print the electronic transcript request form below or download a PDF, complete, and mail, e-mail or fax it to us. Be sure that your signature is included.

Please mail request with the $5 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

Or, you can e-mail this document as an attached PDF (including your signature) to: registrar@knox.edu

Please read the following information about electronic transcripts before you complete this form.

The e-Scrip-Safe network allows Knox to securely transmit an official transcripts in pdf format to a website, from which the recipient can claim it. The recipient is notified by e-mail that an official transcript is ready to be claimed and given instructions on how to do it securely. The student is also informed by e-mail when the transcript has been sent by Knox and given instructions on how to track it at the eScrip-Safe website.

Many institutions belong to the eScrip-Safe receiving network. Before completing your transcript request, check the updated list of these institutions at http://www.scrip-safe.com/products/electronic-transcripts/network-members.aspx and use the institution name as shown. These institutions are set up to receive transcripts easily. You may send electronic transcripts to a non-network person or institution as well. We must have the name of an individual who is to receive it and that person's e-mail address for tracking purposes. Do not simply use an office or business name for the recipient. And you should always notify your intended recipient that they will be receiving e-mail messages regarding the electronic delivery of a transcript. To insure delivery, ask the recipient to add the domain name escrip-safe.com to their safe sender list.

PERSONAL INFORMATION AND BILLING ADDRESS

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

Student Name (Please Print): __________________________________________________________

Street: ____________________________________________________

City: ____________________________________ State:___________

Zip: ____________

Country:_________

e-mail address:______________________________

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) (name)_____________________________________________________

Number of Copies: ______

(e-mail address of recipient)____________________________________

(physical address of recipient)________________________________________

_______________________________________________________

2) (name)_____________________________________________________

Number of Copies: ______

(e-mail address of recipient_____________________________________

(physical address of recipient)________________________________________

_______________________________________________________

3) (name)____________________________________________________

Number of Copies: ______

(e-mail address of recipient)____________________________________

(physical address of recipient)________________________________________

_______________________________________________________

AUTHORIZATION

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

SIGNATURE: _______________________________________________________

Date: ___________________