Request for Temporary Release of Financial Transcript Hold

Part 1 - Agreement to Terms

I am a current or former student requesting temporary release of my financial transcript hold to receive official transcripts.
I understand that this request is only available to U.S. citizen, and I am a U.S. citizen. (International students are not eligible for this request.)
I understand that this release applies to requests for official transcripts only.
I understand that this request applies to release of financial transcript holds only. I may have other types of holds and I understand that this request does not release other holds.
I understand that a response will be sent to the preferred email address I enter in Part 3 of this form.

Part 1 - Agreement to Terms

I understand and agree to these terms listed in Part 1.
I do NOT understand and do NOT agree to terms in Part 1.

Part 2 - Student Identification and Verification

To verify your identify, please provide the required information below.

First Name

Last Name

Date of Birth

Student ID 7-digit number

Your @louisville.edu email address

Part 3 - Notification of Preference

Please list preferred email address for notifications regarding this hold request.

Part 3 - Your Email Address

Part 4 - Reason for Request

Job Application
Transferring to another postsecondary institution (i.e., attending another college or university)
Pursuing opportunities in the military or National Guard
Pursuing other postsecondary opportunities (i.e., graduate or professional programs)
Other, please specify in field below

Part 4 - Other, please specify here

Part 5 - Acknowledgement of Debt

I acknowledge that I have a past due outstanding balance at the University of Louisville. I understand that if I fail to pay the total amount due for all charges:

Registration for future terms may not be allowed.
My past due account may be referred to the university’s collections area within the Bursar’s Office and/or a private agency for collection.
The delinquency may be reported to national credit bureaus.

If my account is referred to a private collection agency, I agree to reimburse the university for collection agency costs, expenses and fees incurred by the university.

I understand that such collection costs, expenses and fees may include fees charged to the university by the collection agency, including percentage-based fees of up to forty percent (40%) of the debt collected. Any collection costs stated above are charged in addition to the principal, fees and interest due on my student account.

I am responsible for paying reasonable attorneys’ fees and court costs associated with collecting or enforcing my past due account.

In the event of a default of my account owed to the university, the university may certify to the Kentucky Department of Revenue (KYDOR) information about me, including my name, social security number, the amount of the debt, and any other identifying information required by the KYOR. The KYOR may then disburse funds to the university in satisfaction of that debt from tax refunds owed to me, if any.

Please visit the Bursar’s Office for more information.

Part 5 - Acknowledgement of Debt

I acknowledge that I owe the University of Louisville an outstanding debt.
I do NOT acknowledge that I owe the University of Louisville an outstanding debt.

Part 6 - Opportunity for a Payment Plan

I would like to be contacted to setup a payment plan to repay my debt. I hereby give permission to be contacted at the Preferred Email Address provided on this form.
I do NOT want to be contacted to setup a payment plan to repay my debt.

Part 7 - Student Authorization

Part 7 - Certification of Named Individual

I certify that I am the above-named individual in Part 2 and I understand that this form cannot be used to request a temporary hold release for someone else.
I do NOT certify that I am the above-named individual in Part 2.

Part 7 - Certification of Information

I certify that the above information is true and correct. I understand that any inaccurate or false information may result in delayed processing or forfeiture of my eligibility to use this form.
I do NOT certify the above information is true and correct.

Office of the Bursar

Request for Temporary Release of Financial Transcript Hold