Print Form CLASS OF 2016 ACADEMIC & LEADERSHIP FELLOWSHIP PROGRAM STEP TWO (2): TRANSCRIPT P LEASE REQUEST DUPLICATE AS NEEDED . TO THE APPLICANT: Please complete and send to the registrar’s office of your undergraduate/graduate school (s) that you have previously attended. Each applicant is responsible for confirming that the required number of transcripts are received by the Program Office. If you have any questions please contact the Program Office at 212.730.7656. To the Registrar of:____________________________________________________________________________________ Please attach this form and forward two (2) official transcripts, affixed with the official seal, for the person named below to the following address: National Urban Fellows Attn: Director of Programs 1120 Avenue of the Americas, 4th floor New York, NY 10036 Name: ___________________________________ First Name (legal name) __________________________________ Last Name _______________________________ Middle Name U.S. social security number: ______ - _______ - ______ Other name (s) under which transcripts may be issued: _________________________________ Dates attended: From:__________________ to ________________________ Birth date: ______ - _____ - ______ Month Day Year Degree obtained, if applicable: ____________________ Your direct phone number: _____ - _____ - _______ To the Registrar of:____________________________________________________________________________________ Please attach this form and forward two (2) official transcripts, affixed with the official seal, for the person named below to the following address: National Urban Fellows Attn: Director of Programs 1120 Avenue of the Americas, 4th floor New York, NY 10036 Name: ___________________________________ First Name (legal name) __________________________________ Last Name _______________________________ Middle Name U.S. social security number: ______ - _______ - ______ Other name (s) under which transcripts may be issued: _________________________________ Dates attended: From:__________________ to ________________________ Birth date: ______ - _____ - ______ Month Day Year Degree obtained, if applicable: ____________________ Your direct phone number: _____ - _____ - _______ Mailing Address: 1120 Avenue of the Americas, 4th floor, New York, NY 10036 P: 212.730.7656 F: 212.730.1823 · www.nuf.org Once you have completed the Transcript Request Form please: • Send to the registrar’s office of your undergraduate/graduate school (s); and • Email a completed Transcript Request Form to the Program Office The subject line should read: 2016 Transcript Request Form; and should be e-mailed to: [email protected] COLLEGE/UNIVERSITY (TO BE COMPLETED BY APPLICANT) DATE REQUESTED FOR NUF STAFF ONLY (TRANSCRIPT RECEIVED) No Yes No Yes No Yes No Yes Thank you. You have now finished completing Step Two (2): Transcript Request. Please proceed onto completing Step Three (3): Program Application.