
University of Connecticut, Office of the Registrar, Transcript Request Form
Student's Name (Last, First, MI):_________________________________________________________________
Student ID # (if known): ______________________________________________________________________
Date: _______/_______/______ Signature: _______________________________________________________
Please Send Official Transcripts of my Academic Record to the following recipients
Please print all information clearly and completely.
Recipient #2
Number of transcripts: _________
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Recipient #3
Number of transcripts: _________
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Recipient #4
Number of transcripts: _________
___________________________________________________________________________________
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Recipient #5
Number of transcripts: _________
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To indicate additional recipients, use additional forms. On the front of these additional forms be
sure to fill in your name, student ID, and date/signature.