Transcript Request Gatton College of Pharmacy

Request for an Official Transcript

Bill Gatton College of Pharmacy

Name*

First Name

Last Name

PharmD Graduation year*

E# (ETSU Student ID#). Alternately, you may provide Date of Birth:*

Email*

To what contact/address should we mail/email your transcript?*

Please upload any documents that should be attached to/ mailed with the transcript (e.g., PhORCAS Transcript Request Form, etc.):

No File Chosen

File uploads may not work on some mobile devices.

If needed, you may upload additional documents that should be attached to/ mailed with the transcript (e.g., PhORCAS Transcript Request Form, etc.):

No File Chosen

File uploads may not work on some mobile devices.

If needed, you may upload additional documents that should be attached to/ mailed with the transcript (e.g., PhORCAS Transcript Request Form, etc.):

No File Chosen

File uploads may not work on some mobile devices.

Please provide any additional needed information about this transcript request (e.g., hold for November APPE grade, submission deadlines, other application instructions, etc.):

FERPA release

By signing below, I agree to allow the Bill Gatton College of Pharmacy to release my requested educational record(s) to a third party indicated on this form. Further, I attest that I am the person named on the requested educational record.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time

: