BETHEL CHRISTIAN UNIVERSITY

Transcript Request Form

APPLICANT:

Please provide the information requested below: Send this form with the
Appropriate transcript fee.

Applicant’s Full Name *
E-mail Address *
Date of Enrolment*
Certificate/Diploma/Degree earned*
Date Graduated*(required)
Field of Study and Major/Concentration*
Name and address where transcript should be mailed *
Your Telephone Number *
Credit Care information: Name on Credit card *
Credit Card Number, Expiration date, and 3 or 4 security digit
number at the back of the card*