Envirovet Transcript Request
Envirovet Summer Institute
Transcript Request Form
Fill in your name and address and send one transcript request to the registrar of each institution you have attended. Be sure to include your current address on each request.
APPLICATION DEADLINE: 1 March, 2010
Class size is limited and complete applications are considered in the order received.
Registrar: Please send a transcript of academic record of
Student ID number: ___________________________________________________________
Name: _______________________________________________________________________
Last First Middle
Address: _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Signature of Student: ___________________________________________________________
Please send transcript to
Director, Envirovet Program
Department of Veterinary Biosciences
College of Veterinary Medicine
University of Illinois at Urbana-Champaign
2001 South Lincoln Avenue
Urbana, IL 61802
FAX: 217.244.1652
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