Use this form to allow a third-party to pick up a document.
Instructions:
** A form must be completed for each separate document to be picked up and is a one-time authorization***
- Student completes all information requested below (including signature – electronic signatures are not accepted).
- A copy of the student’s photo id must be submitted with this form (driver’s license, passport, etc) to confirm the student’s identity.
- Third-party should bring this form and a photo ID to the Penguin Service Center in Meshel Hall, 2nd floor.
Student Information:
Student Name:
Date of Birth:
Banner ID # or Last four of SSN:
Document to be released (check only one). A signed third-party authorization form must be completed for each type of document.
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Document Type
Additional information needed to place order:
Unofficial Transcript (free)
Must have student’s name, birthdate, and YSU ID # or Full SSN
Official Rush Transcript ($12)
Must have student’s name, birthdate, and YSU ID # or Full SSN
Enrollment Verification
Replacement Diploma
Replacement diploma form & payment must be submitted.
Other:
Authorized Third-Party to pick up document:
Full Name:
Person picking up document must present photo ID in order for the document to be released.
I authorize Youngstown State University to release the document indicated above to the third-party individual named. I understand this is a one-time authorization.
Student Signature:
Date:
Signature Required - any form submitted without a written signature will be returned
The third-party should bring this completed form, a copy of the student’s ID (driver’s license, passport, etc.), and his or her own photo ID to the Penguin Service Center in Meshel Hall, 2nd floor. Please call 330-941-6000 if you have any questions.
PSC Use Only:
Confirm:
Student signature _______ Student ID ________ Third-party ID _________ Enter in SPCMNT ________
For Rush Transcript & Replacement Diploma staple to form. All other requests distribute to Records mail.