Admissions and Records Office

Transcript Request

P.O. Box 785

Helena, AR  72342

Fax:  (870)338-7542

 NO TRANSCRIPT WILL BE RELEASED UNTIL ALL FINANCIAL OBLIGATIONS TO PCCUA ARE SATISFIED.  THERE IS NO CHARGE TO HAVE A TRANSCRIPT SENT OR FAXED.

Your signature is REQUIRED in order for PCCUA to release a copy of your transcript.  Therefore, this form must be printed and either mailed to the address above or faxed to the number above.
Please type your information:

Full Name:

Previous Names:

Address:

City:

State:

Zip Code:

Telephone:

Social Security Number:

Birth Date:

Currently enrolled?

Yes No

Last semester of attendence:

Graduated from PCCUA?

Yes No

Attended Rice Belt?

Yes No

Issue immediately

Issue after grades are posted

Issue after

is posted

Issue after CAAP Scores are posted

Issue after grade change for

Check here if you would like to receive an unofficial, student copy sent to the address above.

Check here if you would like to receive an unofficial, student copy faxed to

Check here if you would like an official copy sent to the address above.
Name of Institution that you will take it (required):

Check here if you would like an official copy of your transcript mailed to another institution.

Name of Institution:

Address Line 1:

Address Line 2:

City:   State: Zip:

Check here if you would like an unofficial copy faxed to another institution.  Fax Number: 
Name of Institution: 

You must sign and date this form after printing:

 

 

Signature:

____________________________________

Date:

____________________________________

FOR OFFICE USE ONLY:

Date Received: ______________

Hold:

 __________

If you have any questions, please call the Admissions and Records Office at (870)338-6474 Ext 1150, 1138 or 1336.

Updated June 13, 2005 (AS)