Transcript Request Form

Please write clearly. This form will be used to mail your transcripts.
Please send transcript(s) to:

Name
Address
CityStateZip

Please check appropriate boxes below:

Official (number of copies _______) @ $5.00 per copy ($10.00 per copy for expedited)

Unofficial (number of copies _______) Please include self-addressed, stamped envelope.

Please send immediately
Please send after current quarter grades are posted
Please send after degree posted
Please send after grade change recorded
Please hold for pick-up
I graduated/attended Northwest Institute of Acupuncture and Oriental Medicine (NIAOM)

Transcripts requested by:
Name
Address
CityStateZip

Telephone number(____)______________________
SSN (Student ID #)_______-______-_____________
Date of birth___________________________
Other names used___________________________
Date last attended___________________________

_________________________________________   ____________
Student Signature   Date

Confirmation that transcript was sent:
Date sent

Payment received

Initials


Please send your transcript request to:
The Office of the Registrar
Transcript Services
Bastyr University
14500 Juanita Dr. NE
Kenmore WA 98028-4966