Sauk Valley 173 IL Route 2 Dixon, IL 61021
Community College
Phone: 815-288-5511 Fax: 815-456-4240
TRANSCRIPT REQUEST FORM
Transcript requests require a written authorization and will only be honored if all financial obligations with the College are clear. Request and payment will be returned if obligations exist.
Name: __________________________________________________________________________________
Last First Middle Maiden
Address: ________________________________________________________________________________
Number/Street City State Zip Code
Update Sauk Valley Records: _____YES ______NO
SSN or Sauk ID #: _______________________ Phone: (____) ____________________________
Student Signature: _______________________________________________ Date: _________________
Transcript Request Information: (Please check one)
_____ Send transcripts now!
_____ WAIT! Send after current grades are posted (indicate month and year) _____ / _____
_____ WAIT! Send after degree is posted (indicated month and year) _____ / _____
Unofficial Copies (no charge) Quantity: ________
Official Copies ($6.00 per copy) Quantity: ________
Payment MUST accompany request. Faxed request must include credit card information. (Fax: 815-456-4240)
Mail Transcripts To:
Send Transcripts Electronically:
Name: ____________________________________________ Total Charge:$___________
Name of Card Holder: ___________________________________________ Card Type: _______________
Card Number: _________________________________ Security Code ___ ___ ___ Exp. Date: ___________
(back of credit card)
SVCC provides equal opportunity and affirmative action in education and employment for all qualified persons regardless of race, color, religion, national origin, ancestry, age , gender, martial status, disability, military status, or unfavorable
discharge from military service. Complaints and inquiries related to this policy or any potential discriminatory concerns may be addressed to: Coordinator of Personnel Services, Sauk Valley Community College, 173 IL Route 2, Dixon, IL 61021,
815/288-5511. 5/04
____________________________________
____________________________________
____________________________________
____________________________________
(One Address per Request-Must Provide Complete Address)
To have your Official Transcript sent
electronically, please login to your Student Self
Service Account at https://student.svcc.edu to
make the request through the National Student
Clearinghouse
03/12 For Office Use Only: Date: ______________
Cash Credit Card Check Number___________ Amount Received_________ Initials_____________
