REQUEST FOR OFFICIAL ACADEMIC TRANSCRIPT: CURRENT STUDENT
A current student may authorize the release of his/her official academic transcript by completing this form with an original
signature. The official transcript will not be released in the event of outstanding financial or other obligations to the institution.
Name:
(Last name while enrolled at MCW) (First name) (Middle name)
Street:
City: State: Zip Code:
Phone: MCW E-mail address:
Date of Birth: ________________________
Special Handling (check all that apply):
_____ Please hold request until ___________________________________ grade is posted.
_____ Please hold request until degree is posted.
_____ Please complete attached documents pertaining to my academic record, and include with transcript.
__X__ Please include Dean’s Letter/MSPE with transcript.
_____ Please hold transcript for pick up from the Office of the Registrar
_____ $25.00 Domestic delivery via FedEx (no P.O. box), Recipient Telephone: ______________________________
_____ $50.00 International delivery via Fed Ex (no P.O. box), Recipient Telephone: ___________________________
_____ Other: ______________________________________________________________________________________
Send Transcript to:
Name/Organization: Electronic Residency Application Service
Address: Via Electronic Upload
I hereby authorize the Medical College of Wisconsin to complete any attached documents pertaining to my academic record
submitted with this form, and to process this request for an official academic transcript.
Signature (required): Date: ____________________________
Return this signed form in person to: or Return this form by emailing a PDF of the signed form to acadreg@mcw.edu
Medical College of Wisconsin from your MCW email account.
Office of the Registrar, M3125
8701 Watertown Plank Road
Milwaukee, Wisconsin 53226
(414) 955-8733
