Records Transmittal and Inventory Form

Please complete this form. Note: All boxes are required.

Name of School, College or Administrative Unit:
[Deposit] Accession Number:
Record Series Title (Dean's Office files, Registrar's files, Student Records, etc.):
Date Sent: (e.g., mm/dd/yy)
Depositor’s Name:
Depositor’s Title:
Campus or Other Address:
Please provide the following contact information:
Work Phone:
FAX:
Email:
Inclusive Dates of Records (earliest and latest dates of the records): mm/dd/yy	through
Number of Boxes/Units:
If records are to be scheduled for destruction in the future, the records should be:
recycled
shredded and cost charged to depositor
Box and Folder Contents Listing (A/RM will supply destruction dates based on the University’s Records Retention Schedule or will determine if the records need to be retained permanently. Please make a separate listing for each box):