High School Transcript Request Form
STEP 1: STUDENT INFORMATION
Current Name (Last, First, Middle)
All Other Names Used
BYU Net ID
Current Street Address
City
State
Zip Code
Parent/Legal Guardian's Name (list only one)
Parent/Legal Guardian's Email Address
Standard Advanced
Adult N/A
STEP 2: DESTINATION
FAX # or ADDRESS (include institution/name, street address, state and zip code)
Mail ____ (# of copies) to address:
Standard Mail ($5 per transcript)
Comment or Note
Mail ____ (# of copies) to address:
Standard Mail ($5 per transcript)
Comment or Note
Mail ____ (# of copies) to address:
Comment or Note
STEP 3: SIGN
Signature: (Required)
Date:
Send Transcript Request to one
of the following:
Fax: (801) 422-8501
Mailing Address:
BYU Independent Study
Attn: High School Programs
103 HCEB
770 E University Pkwy
Provo, UT 84602
Note: Credit card information is destroyed once request has been processed!
If paying by check, m
ake payable
to
BYU
Independent Study
.
Visa
MasterCard
Discover
American Express
Cardholder’s Signature Authorizing Charge
Exp. Date
Express ($15 + $5 per transcript*)
Faxed ($10 per transcript)
Express Mail ($15 + $5 per transcript*)
Faxed ($10 per transcript)
Standard Mail ($5 per transcript)
Express Mail ($15 + $5 per transcript*)
Faxed ($10 per transcript)
This form is for BYU Independent Study high school-level courses only. In order to receive your high school
transcript, this form must be filled out completely and submitted to our office. Please make sure that your
grades are posted before submitting this form. Please note that all express mail requests received before 12:00 PM
MST will be sent the day they are received. Please allow 3-5 business days for processing of all other requests.
A confirmation email will be sent to the email address listed on the student's account once charged.
Date of Birth:
Card Number
BYU High School 4-Year
Program (if applicable):
HELPFUL REMINDERS:
• Do not send in request form until after final course grades have been posted on account;
grades not posted are not listed on transcript.
• Tracking #s are only available for express transcripts (usually 24 hours after transcript sent).
• Check with your academic institution to make sure that faxed transcripts are acceptable.
• We cannot fax transcripts to international numbers.
• Express fees for transcripts sent internationally: $19 + $5 per transcript
• Contact info for questions regarding request: (801) 422-8122 or toll free at 855-381-2621
*Each destination requires its own $15 express fee (limit 3 transcripts per express envelope).
STEP 4: PAYMENT
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Parent/Legal Guardian's Phone Number