Academy for Nursing and Health Occupations

Academy for Nursing and Health Occupations

A Private, Not-for-Profit, Licensed and Nationally Accredited College of Nursing

Where dreams of a Better Tomorrow Come True … Learn, Grow, Become …

Located at:
5154 Okeechobee Blvd
West Palm Beach, FL 33417
Phone: (561)683-1400
Fax: (561)683-6773
Email Us

Lois M. Gackenheimer, PhD Ed, MSN, RN
Executive Director / President

Request for Student Records

There is a $5.00 non-refundable fee for each official transcript requested.
There is a $25.00 non-refundable fee for each duplicate diploma requested.

Fill in this form and click the "Generate Request" button below:

Email Address:		(To receive a copy of your request form)
Date of Request:
Name (as printed on school records):
Phone Number 1:
Phone Number 2:
Last 4 of SSN: XXX-XX-
Current Address:
Class Number Attended:
Year of Graduation:

	Student Status:
	Currently Enrolled
	Audit
	Drop
	Graduate
	Program(s):
	Rehab/Restorative Asst.
	Patient Care Tech.
	Practical Nursing
	ASPN
	ADN
	PhTA
	Request(s):
	Reprint of most recent report card (Ask your instructor if you are looking for a new report card.)
	Certificate (list specific certificates)
	Diploma – Original Replacement ($25 fee). No copies are permitted.
	Letter (specify content and purpose)
	Unofficial Transcript (only issued when student has left programs, i.e. graduated or dropped)
	Official Transcript ($5 fee per transcript , mailed only to official institution, e.g. school or Board of Nursing) Reason for this request:
	1098 Form
	Other (specify)
	FA tuition breakdown
	FA ledger
	FA Other (specify)

I authorize ANHO to release the above checked documents to the following:

	Name of Institution:
	Address:
	City, State, Zip:

	Email Address:

	Fax Number:
	Attn:

	I will pick up

	Mail to me
	Address:
	City, State, Zip:

Type your name as an electronic signature (this is equivilant to an actual signature)
Electronic Signature Date: