Covenant School of Nursing
Transcript Request
All obligations to Covenant School of Nursing and Methodist Hospital School of Nursing must be cleared before transcripts may be released. All information is considered confidential.
Please complete all spaces below, SIGN IT, and MAIL or FAX it to the contact information listed.
IF FAXING: (806) 793-0720
IF MAILING: Covenant School of Nursing, 2002 W. Loop 289, Suite 120, Lubbock, TX 79407
Last Name First Name_____________________________ MI________
Other Names Used
Social Security Number Date of Birth_________________________
Current Address
City State_________________ Zip _______________
Email Address
Year Graduated ________________ Do you wish to receive information from the Alumni Association? c Yes c No
Number of Transcripts __________ NOTE: Transcripts are $3 each
c Pick Up Transcript(s) Date Time____________________ (Please allow 3 work days)
c Mail _____ to my current address c Mail _____ to the additional addresses below
______________________________________________
______________________________________________
______________________________________________
Signature Date
The following forms of payment are accepted: Personal check, money order, Discover, Visa, or MasterCard. Please make checks or money orders payable to Covenant Health System.
c Discover c Visa c MasterCard c American Express
Credit Card Number Expiration Date VCode
Name on Card Authorization Signature
Covenant School of Nursing * 2002 W. Loop 289, Suite 120 * Lubbock, TX 79407 * (806) 797-0955 * Fax (806) 793-0720