Transcript Request Form

Transcript Request Form

Skokie Institute of Allied Health and Technology(SIAHT) 2700 Patriot Blvd, Suite: 250, Glenview IL 60026 Phone: (847)461-3985 Fax: (847)510-0463 https://www.siaht.org
Students requesting their transcripts to be mailed, need to fill out the form and pay $15.00 for transcript fee, same day service is $20.00. The same day fee will need to be paid in person while collecting the transcripts. Transcripts will be processed after fee is paid.

Student need to fill out the form seperate if transcripts need to be mailed in more than one address.
Student ID *
Student Name *

First Name Last Name
Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student Email *
Please use the email used while in school.
Student Date of Graduation *

Month Day Year
Name of Contact to send transcript to:

First Name Last Name
Address where transcripts need to be mailed: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Reason for request: *
Pick Up Day and Date

Month Day Year
Transcript Request Fees *
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Transcript Request Form $ 15.00
Should be Empty: