Application for Academic Transcript

AT
Please note Academic Transcripts will not be provided if the student owes money to the University.
Any debts should be paid prior to or when lodging this form.
Please return this form to: Fax: +61 3 9479 1994
Student Administration Office Tel: +61 3 9479 2005
La Trobe University VIC 3086 Email: studentcentre@latrobe.edu.au

Personal Details Student Number

Family Name First Name

Date of Birth Course Title

Telephone (Day Time) Email Address

Request Details
24 Hour Service - $36.00 Please note your transcript order will be processed within 24 hrs we do not
($36.00 for the first copy and $4.00 for each additional copy) guarantee your transcripts will be delivered in 24hrs. *

Weekly Service - $20.00

($20.00 for the first copy and $4.00 for each additional copy) Please note your transcript order will be processed within 5 working days. *
* Australia Post standard mail service. If you require a service such as express post (within Australia) or International Registered courier, additional charges
do apply. For information, contact Student Administration at the Melbourne campus (see above contact).

Total number of transcripts: Amount: AUD$

Results/Completion
If you are a currently enrolled student do you need either of the following:
Production of your transcript to be held until current semester results are released? (Semester 1= Mid - July, Semester 2= Mid - December) Yes No
Do you need your transcript to confirm you have completed your course? Yes No
If you have completed all requirement of your course and are eligible to graduate, you will receive one complimentary official Academic Transcript.
This process is automated - complimentary transcripts are posted out by the second week of the month following course completion. There is no
charge for this service. If you require an Academic Transcript outside of this process, or require additional copies, standard charges will apply.
Collection Method
Pick up
Pick up by a third party (the nominated person will need to provide photo identification) Name:
Send out (please provide a postal address below)
Signature Date Additional Instructions

Address

Suburb/City State Post Code Country

Payment Details
Method of payment: Visa Master Card Cash Cheque
Card Number Expiry Date

Card holder’s name Card holder’s signature

Privacy Policy: Details regarding collection, use, disclosure and access of personal information from this form are available from the following website address:
www.latrobe.edu.au/privacy or by contacting your local Student Administration Office, or telephoning on (03) 9479 2005
CRICOS Provider Number: 00115M
Academic Services March 2013 Version 7