Transcript Request Form


Instructions *

In order to comply with the Family Educational Rights and Privacy Act of 1974 (FERPA), all transcript orders require authorization.

Breining Institute provides the following procedure for authorizing online transcript orders, if:

– You attended Breining Institute any time from 1986 to the present;
– The billing name on the credit card you use to pay for this order matches both the student name on this order and the student name in our records; and,
– The fields in this order including the last four digits of your Social Security Number, Date of Birth, and Signature match the information in our records

Checking student records is a process that occurs after your order has been entered, thus, we cannot tell you definitively at the time of ordering that your order will qualify for Automatic Authorization. If we successfully authorize your order, we will send the transcripts to your designated party within ten days of receiving a complete order. If we are unable to automatically authorize your order, we will send you an Authorization Form that you must then sign and return via fax or mail before your order can be completed.

If you do not wish to submit your Transcript Request online, you may print and complete this form, and then send to us by email, facsimile or postal mail.

The Office of the Registrar takes responsibility for handling transcript requests in a prompt and efficient manner. However, we are not responsible for mishandling by the U.S. Post Office or the receiving school or agency.

Student Info *

Section 2: Student Information

Attendance Info *

Where to send *

Section 4: Where do you want these transcripts sent?
We will send one set of transcripts to the individual and/or institution you identify within this section. We will send them by regular First Class mail, using the U.S. Postal Service (USPS). If you desire expedited service, you may select the USPS Priority Mail option when completing the Payment Information. If you, the student, would like to order an electronic PDF copy of your transcripts be emailed to you, you may select that option, below. An electronic PDF copy of transcripts is only available to be sent directly to the student, to the student email provided in Section 2: Student Information.

Payment Info

Section 5: Order
PLEASE NOTE: You may order a maximum of two transcripts per order, to be sent to one address. If you need additional transcripts, or need them to be sent to different addresses, you will need to submit a different order for each different address.
Section 6: Credit Card and Payment Information
Please carefully use this space to sign your name, which must match the signature we have on record in your student file.
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