<p>Registry 2011 Revised BETHLEHEM MORAVIAN COLLEGE (A Multidisciplinary Institution, Founded 1861) TRANSCRIPT REQUEST FORM</p><p>Please indicate the type of document being requested:</p><p>Official Transcript [ ] Unofficial Transcript [ ]</p><p>Has the above document been If yes, please indicate the date of last request Is the applicant a current requested before? BMC student? ______/______/______Yes [ ] No [ ] Month Day Year Yes [ ] No [ ]</p><p>Title: Name under which last registered at BMC (Please indicate in full caps) Miss [ ] Mrs. [ ] ______Mr. [ ] Last First Middle ID #</p><p>Date of Birth: Contact Number:</p><p>______/______/______Cell: ______Month Day Year Work: ______Home: ______Current Mailing Address: Email Address(s):</p><p>Program of Study: Start date: End date: Date of last final or re-sit exam: MM/YY MM/YY Re-sit Exam [ ] Level of study: Final Exam [ ]</p><p>Associate Degree [ ] ___/______/_____ Diploma [ ] Bachelors Degree [ ] MM DD YY Give the full name and address of the institution where the document is to be sent. ______</p><p>TRANSCRIPT SPECIFICATION (Please omit if not applicable) Purpose of transcript:</p><p>School [ ] Embassy [ ] Job [ ] Other ______</p><p>Please note: A transcript is a confidential document which is sent from BMC for the above purposes based on authenticity. BMC holds every right to verify information given. Payment Received: $______Cost of transcript: Three weeks & Beyond- $500.00 [ ] Five-Ten days- $1000.00 [ ] Receipt No. & Date: ______Overseas(by mail)- US$20 (equivalent) [ ] Unofficial Copy - $250.00 [ ] Receipt Issued By: ______Tamper Proof Envelope- $300.00 [ ] No. of Transcripts:______NB. The costs listed above do not include courier charge. Please indicate the method of dispatch</p><p>Courier service [ ] Registered mail [ ] Other ______</p><p>Name of person Date requested: Name of person collecting: Date collected: completing form:</p><p>FOR OFFICE USE ONLY (Do not write below this line) Date sent: Sign. Of Transcript Clerk: Sign. of dispatch personnel:</p><p>The timely processing of your document(s) is based on the accuracy and completeness of the information supplied.</p>