Document Request Form

Document Request Form

Student Transcripts or Duplicate Completion Certificate/Diploma Request

School transcripts and duplicate completion certificates/duplicate diplomas will be issued by the institution’s Office of Student Affairs.

In order to ensure that the student’s records are confidential, InterCoast will issue official transcripts only upon receiving written authorization of the student. In accordance with federal law pertaining to the Family Educational Rights & Privacy Act, transcripts will not be released to a third party without the student’s written permission.

The cost to order an official transcript or a duplicate copy of a completion certificate/diploma is $25 per request. If a Tracking Number is requested the additional fee is $10 per request, for a total of $35.

The school will send an initial (first) Verification or Certification of Graduation without charge. However, the cost to order subsequent Verification or Certification of Graduation to be sent on behalf of the student is $20.

Unofficial transcripts can be emailed to the student at no charge. There is a fee of $10 for an unofficial transcript to be mailed.

To order a transcript or a duplicate copy of your certificate/diploma, please submit a completed form and money order or cashier’s check made payable to InterCoast to the following address:

InterCoast Colleges Office of Student Affairs

Attn: Transcript Request

P.O. Box 3585, Granada Hills, CA 91394-3585

Student may also pay for the document and tracking fee with a credit or debit card by completing that information on the request form. The completed Request Form can be scanned and emailed to: transcripts@intercoast.edu or submitted by fax to (818) 717-7945. It will not be processed until payment is received/processed.

Requested documents are mailed via US Postal Service to the address as designated on the completed Request Form. All requests are processed in the order received. Requester should allow 10 business days in addition to postal mail time for records to arrive to the requested destination.

First Name*

Last Name*

Maiden name or other name while attending

Last four digits of Social Security Number*

Date of birth*

Daytime Phone Number*

Billing Address (Street or PO Box)*

Billing Address (City, State, ZIP)*

Email*

Campus*

Select or enter value

Program*

Select or enter value

Date of Graduation*

Purpose of Request*

Select or enter value

Type of Document Requested*

Select or enter value

# of copies Requested*

Tracking # Requested (addl charge $10)*

Select

Statement of Certification of Electronic Signature

In accordance with federal law pertaining to the Family Educational Rights & Privacy Act, transcripts will not be released to a third party without the student’s written permission.

By typing my name here I am signing this document electronically, I certify that the information above was provided by me and I certify that my electronic signature used on this document is a legally binding equivalent to my handwritten signature.

Type your full name here to certify your request.*

Send to: (Name of Person, Company, or Institution)*

Transcripts are mailed to the address you provide below.

Board of Nursing application docs are mailed directly to PCS (Massachusetts), BVNPT (California) or other state board of nursing.

Send to: (Address)*

Send to: (City, State, ZIP)*

If paying with a debit or credit card, please complete the following. Paying by credit card on our web form is encrypted and secure. However, students may call 818-672-2100 to give card number over the phone.

Indicate Credit Card Type

Select

Credit Card Number

Expiration Date

Name on Card

VIN Code 3 digits for MC, VISA, Discover

Send me a copy of my responses

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