OFFICE OF THE REGISTRAR
THE UNIVERSITY OF NORTH CAROLINA AT PEMBROKE

TRANSCRIPT REQUEST FORM

Directions: Please print, complete and return to the Office of the Registrar.

Last Name First Middle Address City State Zip Code Previous Name or Name Used Student Number Birth Date Telephone Number Number of Copies__________($5.00 per Copy, $5.00 per fax, $10.00 Same Day Service) Please note that ALL financial obligations to The University of North Carolina at Pembroke must be met before transcripts can be mailed.       Print plainly the address or fax number above to which transcript is to be sent. (Please only one address per form) Check or fill in Appropriate Boxes [ ] Send Transcript(s) Now [ ] Undergraduate (Bachelors) [ ] Pick-up [ ] Graduate (Masters) [ ] Same Day Service [ ]Hold for Current Term Grades [ ] Fax [ ] Hold For Posting of Degree Beginning Enrollment Date Ending Enrollment Date Please indicate any special instructions or comments below. Important: I realize my Social Security Number may or  may not be printed on the requested transcript.  By signing this form I am giving UNC-Pembroke permission  to print my Social Security Number on the transcript which will be disclosed to the person receiving it. Required Signature & Date ***********************************Office Use Only************************************* Type of Hold Notified Date Sent or Picked Up Amount Paid

Please return completed form to:

Office of the Registrar
PO Box 1510
Pembroke, NC 28372-1510

Office Location: Lumbee Hall, Room 133

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