NGA - Diploma/Transcript Request Form

DIPLOMA/TRANSCRIPT REQUEST FORM

Request Regulations

Diploma reprint $29.
Official Transcript $ 10.
All requests must be authorized by the student’s signature in accordance with the Family Educational Rights & Privacy Act (FERPA). Diplomas will be sent out as quickly as possible, in the order that requests are received within 3-5 days after any required payment is received. During registration, final exams, and graduation expect an additional delay.
Picture identification is required. Please attach a copy of your driver’s license or State ID to this form.
Diplomas will not be issued if any debts are due to the school or if any admissions requirements have not been met.
Official copies of credits transferred to Excel Education Systems Schools must be requested directly from the institution where the credit was completed.
If you have questions about this process, please call the school central offices at 763-412-4701.

Section 1 - Student Name*

First Name

Middle Name

Last Name

Section 2 - Student Enrolled Name (If different)

First Name

Middle Name (optional)

Last Name

Student ID #

Section 3 - Email Address*

Section 4 - Home Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Section 5 - Student Date of Birth*

Section 6 - Graduation Year*

Section 7 - Request Type & Total*

1 Transcript ($10) 2 Transcripts ($20) 1 Diploma ($29) 2 Diplomas ($58) 1 Padded Diploma Cover ($20) Replacement Graduation Packet ($59) (Includes: Congratulations letter, Official Sealed Transcript, Diploma and Diploma Padded Cover) Multiple Transcripts (Indicate in the notes below how many transcripts and total to charge) 1 International Shipping ($100 Flat Rate) 2 International Shipping ($200 Flat Rate)

Section 8 - Indicate Total To Charge: Add all checked boxes in section 7 = Total Owed)*

Credit Card Number*

Credit Card Exp. Date MM/YYYY*

Credit Card CVV (3-digits Visa/MC/Discover) (4 digits AMX)*

Section 10 - Mailing Information: Institution/Company/Person*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Section 11 - Additional Mailing Information: Institution/Company/Person

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Section 12 - Signature*

[clear]

Use your mouse or finger to draw your signature above

Section 13 - Date/Time*

:

Section 14 - Upload Government ID Here*

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