Request for Official Transcript
Please return this form with the student's official transcripts

Institutional Information
Institution Name_____________________________________________  Date_______________
Institution Address_______________________________________________________________
Institution City_____________________________ Institution State____ Institution Zip________
Name used while attending the Institution_____________________________________________
Last year of attendance___________


Personal Information
Last Name_____________________________ First Name________________________ MI___
Address______________________________________________________________________
City___________________________________ State_____ Zip___________
SSN__________________ Birthdate____________
Home Phone_____________________ Cell Phone_____________________


Authorization
I hereby authorize you to send an official copy of my transcripts to:
Briar Cliff University
Admissions
3303 Rebecca Street
Sioux City, IA 51104

Please check one   send as soon as possible  send after current term grades are posted
Check is attached
Please send invoice to address listed above

Signature___________________________________________________

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