Web Transcript Request - Ordering Transcripts

Please print this transcript request form below or download a PDF, complete, and mail, email or fax it to us.

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 email this document as an attached PDF (including your signature) to registrar@knox.edu.

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: ___________________