Summary: TRANSCRIPT REQUEST FORM
The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. The information collected will be
used by the Office of the University Registrar to process your request as identified on this form. For more information, please contact us by mail at
The Office of the University Registrar (Records and Services), Queen's University, Gordon Hall Room 125, 74 Union Street, Kingston,
Ontario, K7L 3N6, or by phone at 613-533-2040.
If you are sending to more than one destination, please use additional forms.
COST: $15.00 PER COPY, COURIER CHARGES EXTRA
MAIL FORM WITH PAYMENT TO THE ABOVE ADDRESS, ATTN: TRANSCRIPT CLERK
STUDENT NUMBER (if known)
Today's Date: Year________ Month___Day___ Date of Birth: Year________ Month____Day____
School/Faculty at Queen's (eg Applied Science, Medicine): Your Name and Address:
________________________________________ Last Name: _______________________________
Maiden Name (if applicable): __________________
Are you a currently registered student?
YES NO Address:___________________________________
Apt./House # Street
Year in your current program?