Indiana University Northwest
 

Office of the Registrar
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Transcript Request Fee Form

Office of the Registrar-Transcripts
Indiana University Northwest
3400 Broadway
Gary, IN 46408-1197
FAX (219) 981-4200 and verify receipt by calling 219-980-6679

Attention!!

This fee is a non-refundable fee, not applicable to any other university bill or fee. Your official IU transcript request cannot be processed until the fee has been paid.

If you are paying your fee by credit card:

  1. Print this form.
  2. Fill out the personal information on this form.
  3. Fill out the credit card information on this form.
  4. Sign and date the form.

When we receive this information, your credit card will be charged $7/transcript ordered.

Personal Information:
Name _______________________________________________________________
 
Street _______________________________________________________________
 
City _______________________ State ______________ Zip ______________
 
Phone (Include Area Code) ___________________________
Credit Card Payment Information:
____Visa ____MasterCard ____Discover
 
Name on Credit Card: _______________________________________
Credit Card Number: _________________________
Credit Card Expiration Date: _________
 
Signature of Card Holder: ____________________________________________
 
Date: ________________________