USF Continuing Education Participant Record Request Form

To Request by Mail: Include this completed request form with your credit card information ($12 per request). Please sign and date the form.

To Request in Person: Bring your completed form and credit card ($12 per request) to Continuing Education Registration Services, USF Tampa, Building NEC. Office hours are M-F from 8:30am to 4:00pm. For information or directions, call 813-974-2403, and press 1 for Registration Services.
Note: Your request will be processed and mailed within 5 working days.
PARTICIPANT INFORMATION

Request Date:   
Your current name and address:

First Name:

  M.I.

Last Name:

Street/P.O.:

City:

 State:  Zip Code

Country:

Evening Phone:   Day Phone:
Your ID# and your name and address (if different) at the time of registration:
Note: Your social security number (SSN) is optional, but helps us maintain your records accurately.
SSN: (optional) OR Continuing Ed. Student ID #
First Name:   M.I.
Last Name:
Street/P.O.:
City:  State:  Zip Code
Country:

PAYMENT INFORMATION

Record Fee: $12 per copy         Number of Copies:           Total Cost: $

Include Foreign Postage Surcharge ($3) for addresses outside the United States

Payment Type:

 

Print and sign form.
Bring/mail with credit card information to:

Continuing Education Registration Services
University of South Florida
4202 E. Fowler Ave., NEC116
Tampa, FL 33620-6758 USA

Credit Card Number

  

Credit Card Exp. Date: 

 

Cardholder's First Name:

 

Cardholder's Last Name:

 

 Signature of Requestor:___________________________________________________________________

Your transcript will be placed in a sealed internal envelope marked "Transcript Enclosed" within the mailed envelope. If you are forwarding the document as an official transcript, do not open the envelope.
 OFFICE USE ONLY:    Receipt Date: Mail Date: Amt. Received:
 Registration Processing: Dept. Processing: Extra Postage: