REQUEST FOR ACADEMIC TRANSCRIPT FORM

DETAILS
□ Tick if you have not provided ‘Details’ below because you have already provided details in the attached Request for Parchment Form
Name on Transcript: _____________________________________________________________________________
Dale George Naughton
Please provide the name as you want it to appear in your Academic Transcript. If different from your name on your
Application Form, please provide evidence (i.e. CTC of Marriage Certificate etc)

Family Name: _______________________________

Naughton Given Names: _______________________________________
Dale George
Email Address: ___________________________________________
dale274@gmail.com AIB Student ID No: _______________________
A001321237
Postal Address: __________________________________________________________________________________
41-42 New Market/Main Streets, Georgetown, Guyana
N.B for Teaching Centre students, Academic Transcripts will always be posted to the Teaching Centres’ address.

Study Mode: Adelaide Campus/Distance Learning/ Teaching Centre (Teaching Centre name):____________________
(circle one)

Date Commenced: ____/____/____

07 09 13 Date Completed: _____/____/____
11 11 14
Course: PhD/DBA/MBA/BBA/Certificate (circle one) Specialisation: _________________________________

REASON FOR REQUESTING ACADEMIC TRANSCRIPT:

□ Completed course (state your date of completion:) _______________________
□ Partially completed course at exit point
□ Replacement or additional academic transcript required.
□ Other: _______________________
AIB RETAINING ACADEMIC TRANSCRIPT:
□ Yes, I would like AIB to retain my academic transcript as I may attend AIB’s Graduation (I understand that I need to
register for the Graduation separately)
□ No, I would like my academic transcript to be sent to the above postal address.
STEPS IN REQUESTING YOUR ACADEMIC TRANSCRIPT:
Step 1: Confirm the full name of the course
Eg MBA (Finance), GCM, Associate Degree, etc: ___________________________________________
MBA (Generic)
Step 2: Insert your required number of Academic Transcript copies and fee
$25 for an Academic Transcript and $5 for each additional copy. ______________ $
However, 1 Academic Transcript is provided at no charge upon Insert no. of copies
completing or exiting from the Course.
Step 3: Insert the postage fee
$0 for pick up; otherwise please contact us regarding amount of postage fees
$
Step 4: Insert the fees for your mode of payment
For students within Australia $0 for EFT; additional 2% for credit card payment $
For students outside Australia $15 for TT; additional 2% for credit card; $0 for Custom House
Please access http://www.aib.edu.au/payments.html for modes of payment
For credit card payment, you can alternatively fill in the credit card details below
Step 5: Add up the amounts in the boxes and insert the Total amount payable TOTAL: $
Step 6: Provide us with this completed Form and make payment
Either submit this Form to your Teaching Centre or fax it to AIB at +61 8 8212 0032
Complete this section if you are paying by credit card as indicated in Step 4 above
I hereby authorise Australian Institute of Business to debit the above Total amount from the below credit card.
Credit Card Number: _______________________________________ Expiry Date: ______________
Card Holder’s Name _______________________________________ Card Type Visa/Mastercard (circle one)
Card Holder’s Signature: ____________________________________ CVV no.: ______________
N.B If you are requesting a nested award (e.g. GCM, GDM, Diploma, Associate Degree) but at the time of approval
by the Academic Board you are eligible for a higher award, you will only receive the higher award.

V2-18.04.12