Brooklyn Campus
Long Island University Registrar's Office
Transcript RequestUniversity PlazaBrooklyn, New York, 11201
718-488-1013
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If you attended under another name, indicate:

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Last First Middle

Your telephone number (_____)___________________________

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Signature Date

Soc Sec/ID# :___________________________ Birth Date: _________________

Division of LIU Attended:____________________________________________
Undergraduate or Graduate___________________________________________
Dates of attendance: From___________ To _____________
If currently in attendance, do you want transcript held for:
Semester grades: Yes _______ No _______
Indication of degree: Yes _______ No _______
If LIU graduate, indicate:_____________________ ______________________
degree date
Official______________ Unofficial________________

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FIRST MIDDLE LAST

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CURRENT ADDRESS

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CITY STATE ZIP CODE

  
 
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