Request for Transcript

 

Name:                                                                            Signature:                              ______

 

Address:                                                                                                                                 

 

Phone:                                                                           Date:                                                

 

Degree(s) received/pursuing from LSTC:                                                         Date:            

                                                                 

                                                              Date:            

 

Please send ___ transcript(s) to:

                                                                                                                       

           

                                                                                                                       

 

                                                                                                                       

 

                                                                                                                       

 

Please send ___ transcript(s) to:

                                                                                                                       

           

                                                                                                                       

 

                                                                                                                       

 

                                                                                                                       

 

Transcripts will not be sent if the requester has an outstanding balance at LSTC.

The first copy ever requested is free; subsequent copies are $5.00 and must accompany the request. Copies to synods/scholarships are free.

 

Date received:                          Date sent:                                by                              

 

Business Office Approval:                            

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LSTC Credit Card Form [ Download This form as PDF]

1100 East 55 th Street ~ Chicago, IL 60615 ~ 773-256-0700 ~ 773-256-0782

To expedite your transcript request, you must complete this entire form and include it with your request. There is a $20 minimum with credit card payments.

 

 

LSTC Account ID ____________ Name_________________________________ Phone _______________________

 

Method of Payment (Indicate One): ____ Check (Payable to “LSTC”) ____ Credit Card (Authorize below)

CREDIT CARD MINIMUM: $20

Credit Card Number: ¨ ¨ ¨ ¨ - ¨ ¨ ¨ ¨ - ¨ ¨ ¨ ¨ - ¨ ¨ ¨ ¨

 

Type: ___Visa ___ Master Card / Expiration date: MM: _______YR: _______

Payment Amount $__________________ CREDIT CARD MINIMUM: $20

Name of Cardholder: ________________________________________________________________________________

 

Card Billing Address: ______________________________ City________________ State _________ Zip___________

Authorized Signature: __________________________________________________ Date:________________________

THANK YOU for your prompt attention to this important matter!