Transcript Request Form

Office of Recruitment and Admissions • Graduate Studies

2800 Victory Boulevard • Staten Island, NY 10314

Building 2A, Room 103

T 718.982.2019 • F 718.982.2500

www.csi.cuny.edu/graduatestudies

TRANSCRIPT REQUEST FORM

Official t

ranscripts are required for each college or university that you have ever attended. This form is provided to assist

you in requesting your transcripts. Feel free to duplicate it if you need additional copies. Please complete this form and

submit it to the appropriate department at your previous school. Additional forms and/or a fee may be required by your

school.

TO: Registrar/Student Records Officer/Controller of Examinations

_____________________

__________________________________________________

Name of colleg

e/university

_____________________

__________________________________________________

Address

_____________________

__________________________________________________

City State Zip Code

_______________________________________________________________________

Country (if

outside of the U.S.)

_______________________________________________________________________

FROM:

Name of studen

t Other name used while in attendance

_______________________________________________________________________

Address Student ID#

_______________________________________________________________________

City State Zip Code Dates of attendance

_______________________________________________________________________

Telephone#

Date of graduation

Please be i

nformed that I have applied for admission to the College of Staten Island of the City University of New York

(CUNY) as a graduate student. In order to complete my application, I am required to submit an official transcript from

your institution. Please forward my transcripts to the address listed above – attention graduate admissions.

Thank you for your assistance

Sincerely,

Signature Date

Revised 9/25/13

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