INMED Transcript Request Form
Please allow 5 – 7 business days to process transcripts.
Personal Information
Student Name
*
First Name
Last Name
Personal Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Email
*
example@example.com
Confirm Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Student ID (optional)
Has your name changed since attending school?
*
Yes
No
My name while attending school:
*
First Name
Last Name
Recipient Information
Who are you sending your transcript to?
*
College or University
Educational Organization, Application Service, Scholarship, and Professional Licensing
Employer or Other
Myself
What type of transcript are you requesting?
*
Unofficial Transcript (Electronic copy will be sent via email, free of charge)
Official Transcript (Transcript will be mailed and is subject to $10 fee USD)
Provide Delivery Information (Email Recipient Name):
*
First Name
Last Name
Provide Delivery Information (Email Recipient):
*
example@example.com
Provide Delivery Information (Mailing Address Name):
*
First Name
Last Name
Provide Delivery Information (Mailing Address):
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is there anything else you would like INMED to know?
My Products
*
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Official Transcript
Official transcript fee is $10 (USD) per transcription request
$
10.00
Unofficial Transcript
Electronic copy will be sent via email, free of charge
$
Free
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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submit
the form.
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