Transcript Request Form

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.

Section 1: Student Information
Section 3: 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, below.
Section 4: Order
Section 5: 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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