Transcript Special Request Form
This form is ONLY for the special transcript requests listed below.
All standard official transcript requests must be submitted online at banweb.pdx.edu.
See www.pdx.edu/registration/transcript-requests for more information.
1. Student Information
Student ID Number
Date of Birth
Last Name
First Name
____________________________________________________
Middle Name
Former Name(s)
Current Mailing Address
City
State
Phone Number
Years of PSU attendance (please check all that apply):
E-mail Address
prior to 1962 1962-1974 1975-1980 1981-1991 1992-present
2. Special Request
3. Delivery Method
Select required special request quantity/type (section 2)
AND delivery method (section 3)
Total number of transcripts requested:
All standard official transcript requests must be submitted
online at banweb.pdx.edu. This form is ONLY for the
following special requests.
Enclosure – I have a cover sheet or special enclosure to
include with my official transcript.
(please attach enclosure)
Hold – I have received special permission to override a
transcript hold on my record.
Legacy Unofficial – I attended before 1991 and need a
copy of my unofficial transcript.
(no fee for Legacy Unofficial transcripts)
Notary Service – I need the additional step of having my
official record notarized by a notary public.
(additional 2-3 days processing)
Paper Request – I want to submit my transcript request
via paper and do not have one of the special requests listed
above.
Pick up in-person – $8 per copy + $10 processing fee
Authorized to Pick Up: __________________________________
Fax – $8 per copy + $10 processing fee
Attention: ____________________________________________
Fax #: ______________________________________________
Standard Mail – $8 per copy + $10 processing (1-2 day
processing)
Name: _______________________________________________
Address line 1: ________________________________________
Address line 2: ________________________________________
City, State, Zip: ________________________________________
Domestic FedEx – $8 per copy + $30 processing/S&H fee
(no PO box - physical address only & phone number required)
Name: _______________________________________________
Address line 1: ________________________________________
Address line 2: ________________________________________
City, State, Zip: ________________________________________
Recipient Phone # (req’d): ______________________________
4. Authorization & Payment
Student Signature
- I authorize PSU to release my transcripts to the parties indicated above.
Date
Signature Required – Unsigned requests will not be processed.
Payment
C
heck Enclosed
(payable to PSU) Credit Card Number Exp. Date
Visa/MC _______________________________________________________________________________
Portland State University Attn: Transcript Requests PO Box 751 Portland, OR 97207-0751
Fax: (503) 725-5525 Phone: (503) 725-3220 transcripts@pdx.edu
Rev. 11/22 – Records | transcript_special_request.doc