Transcript Request Form

Instructions *

Transcripts may be ordered by the student.

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 or institution you identify within this section.
  • If a paper transcript is requested, we will send it by regular First Class mail using the U.S. Postal Service (USPS), to the mailing address you provide below.
  • If an electronic PDF copy of transcripts is requested, it is only available to be sent directly to the student. If you, the student, would like to order an electronic PDF copy of your transcripts, you may select that option, below.
If the Student is ordering a personal copy of the PDF transcript, it will be emailed to the email address that you input below.
This is the person or institution that will be mailed the transcript. If it is you, please include your full name. If it is an institution, it is a good idea to have it addressed to an individual.

Payment Info

Section 5: Order
PLEASE NOTE: If you need additional transcripts, 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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