Transcript Request and Payment Form
Secure On-Line Submission

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Thank you for studying at
Jerusalem University College
All fields are required to be completed.

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Today's Date:   	(month/day/year)
Title:			Dr.Prof.Rev.Mr.Mrs.MissMs.
First Name:     	
Middle Initial:		
Last Name:      	
Phone Number:   	(with area code first)
E-mail Address: 	
Address line 1:		
Address line 2:		
City:			 State: Zip:
Transcripts are $10.00 each for normal mail delivery from Israel.
(This takes two to three weeks)
For Federal Express delivery ADD $40.00 per location.
(A total of $50.00. This takes one week or less)
For Faxed transcripts $10.00 each.
(Note faxed transcripts are not 
considered official by most institutions)

Card Type: 		
Card Number: 		
Expiration Date:	(month/year)
Number of Transcripts:	
Federal Express:	 (yes or no)
Fax the Transcript:	 (yes or no)
JUC Program Name:      	
Date of your program:	

Enter in the text window all name and address information
(and fax number if applicable) necessary to get your transcript to the correct person.
Note: For Federal Express requests you must include a phone number
for the location of the delivery.

Thank you once again for studying at JUC!

Please note:  Your payment will be processed and, if the charge is approved, your transcript request will be processed per your instructions.  You will be sent a receipt in the mail to the address you indicate and notified at the e-mail address you specify when the transaction is completed.  Sending the form does not constitute a receipt for the charge, only a request to process it for you.

Instructions for Submission
 1) Please review your information before submitting.
2) Click the "submit" button only once.
3) A new screen will appear confirming what has been sent which
you may print out as a record of your submission.

If you have trouble completing or sending the form please contact
the admissions office by e-mail: