Transcript Request Form

Transcript Request Form
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Personal E-mail Address *
example@example.com
Social Security Number *
Please Release a Copy of My Transcripts to:
Office or Department: *
Name of Institution *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail Address *
To the Attention of:
Is this your first transcript request? *

Yes No
Transcript Fee: No charge for first copy of transcript requested; $10.00 for each subsequent copy.
Signature (Use your mouse cursor to sign) *
Date *

Month Day Year
A transcript will not be released until all financial obligations to Southern Methodist College has been satisfied.

Trasncript Fee

USD or mail to Southern Methodist College at 541 Broughton St. Orangeburg, SC 29115

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Should be Empty: