Ochsner Clinic Foundation School of Allied Health Science Request for Transcripts

OCHSNER SCHOOL OF ALLIED HEALTH SCIENCES

REQUEST FOR TRANSCRIPT

Processing takes 7 working days. $5.00 per copy payable by check or money order to Ochsner Clinic Foundation. DO NOT SEND CASH! Please PRINT the following information:

Program graduated from:

Year Graduated:

Name (Last,First, MI):

Name used while attending:
(if different from above)

Social Security #

Present Address

City/State/Zip Code

Please send _____ transcript(s) to the following address. Note: only one address per request.

Signature and Date:

Send completed form to: Ochsner School of Allied Health Sciences
1514 Jefferson Highway
New Orleans, LA 70121

For Office Use Only:	Date Request Received:__________________

	Date Transcript Sent Out:__________________

Program graduated from:
Year Graduated:
Name (Last,First, MI):
Name used while attending: (if different from above)
Social Security #
Present Address
City/State/Zip Code





Signature and Date:
Send completed form to:	Ochsner School of Allied Health Sciences 1514 Jefferson Highway New Orleans, LA 70121