Dmacc Transcript Request Form – Fill Out and Use This PDF

Transcripts will be mailed free of charge. There is a $5.00 per transcript charge for faxing. NOTE: After grades are available on the web and for 2 weeks following, faxing or 24 business-hour processing is NOT available. Normal processing time is 3-4 business days once requests are received.

*You are responsible to determine if all grades/awards are confirmed before transcripts are mailed.

PART 1 Student Information(Please Print)

DMACC ID or SSN	(ALL FIELDS ARE REQUIRED)

Name ________________________________________________________________________________________________________

(Last)(First)(M)

Former Last Name(s):___________________________________________________________________________________________

Street/Box No. _________________________________________________________________________________________________

(Apt.)

City/State/Zip: __________________________________________________________________________________________________

Telephone: (_________)__________-__________________________ Birth Date: ____ ____/ ____ ____/ ____ ____ ____ ____

				Month	Day	Year
Did you attend DMACC prior to 1978?			Yes	No
Did you earn your high school diploma through DMACC?			Yes	No
Type of Transcript Requested:		Credit	Noncredit
Issue Transcript Now:	Yes	No (If no, transcript will be issued after grades are recorded.)

PART 2 Send Transcript (ALL FIELDS ARE REQUIRED)

Please mail an official copy of my transcript to:

College/Business: _____________________________________________________________________________________

_______________________________________________________________________________________________

Mailing Address: ______________________________________________________________________________________

City/ST/Zip: __________________________________________________________________________________________

Check here if you want a student copy sent to my address printed in Part 1 of this form.

Check here if you want to pick up a student copy. (Processed within 48 business hours)

Fax #: ______________________________ (faxed transcripts considered unofficial by receiving institution)

PART 3 Payment for Faxes

TYPE OF PAYMENT: Master Card

VISA

Discover

Check (must be enclosed with request)

Card Holder Name: _____________________________________________ Day Time Phone #: _______________________

Account Number: ______________________________________________ Exp. Date: _______________________________

Total Amt. Charged: $________________

PART 4 Student Authorization (Your signature is required to release a copy of your transcripts.)

I authorize DMACC to send my transcript as outlined above.

______________________________________________________________	_________________________________
(Student Signature)	(Date)
	Supersedes all forms prior to 8/11