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TRANSCRIPT REQUEST FORM
Transcript Information
Incomplete requests will not be processed.
Mail this completed form to:
DMACC Transcript Dept.
2006 S. Ankeny Blvd., Bldg. 1
Ankeny, IA 50023-3993
Or Fax: 515-965-7111
Or Email Form: transcripts@dmacc.edu
Transcripts will be mailed free of charge. NOTE: Processing time is 3-4 business days once requests are received.
After grades are available on the web, processing time may take longer. (During peak times there is NO special
processing).
*You are responsible to determine if all grades/awards are confirmed before transcripts are mailed.
PART 1 Student Information (Please Print)
(ALL FIELDS ARE REQUIRED)
Name ________________________________________________________________________________________________________
(Last) (First) (M)
Former Last Name(s):___________________________________________________________________________________________
Street/Box No. _________________________________________________________________________________________________
(Apt.)
City/State/Zip: __________________________________________________________________________________________________
Telephone: (_________)__________-__________________________ Birth Date: ____ ____/ ____ ____/ ____ ____ ____ ____
Did you attend DMACC prior to 1978? Yes No
Did you earn your Adult High School diploma through DMACC? Yes No
Type of Transcript Requested: Credit
Noncredit Both
Issue Transcript Now:
Yes No (If no, transcript will be issued after grades are recorded.)
PART 2 Send Transcript (All Fields Required)
Please mail a copy of my transcript to:
College/Business:_____________________________________________________________________________________
Attn: _______________________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
City/ST/Zip: __________________________________________________________________________________________
Please mail a copy of my transcript to:
College/Business:_____________________________________________________________________________________
Attn: _______________________________________________________________________________________________
Mailing Address: ______________________________________________________________________________________
City/ST/Zip: __________________________________________________________________________________________
Check here if you want a student copy sent to my address printed in Part 1 of this form.
PART 3 Student Authorization (Your signature is required to release your transcripts.)DMACC Does not accept
An Electronic signature.
I authorize DMACC to send my transcript as outlined above.
_________________________________________________________
(Student Signature)
_____ ________
(Date)
_________________________
Supersedes all forms prior to 12/16
click to sign
signature
click to edit
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