Printed Name ______________________________ Maiden name/othe
r ________________________
Address __________________________________ Home Phone _____________________________
_________________________________________ Cell Phone ______________________________
_____________________________________ Campus ID ______________________________
_________________________________ Social Security # __________________________
Email ____________________________________ Birth date
_______________________________
Are you a current student? ___ YES ___ NO Last year of attendance at DWU _____________
Should we hold your transcript to include the current semester’s grades? _______ YES _________ NO
Purpose of release ___________________________________________________________________
Name(s)/Address(es) where to mail (use additional paper if needed; cannot be an email address):
______________________________________ ________________________________________
______________________________________ ________________________________________
______________________________________ ________________________________________
______________________________________ ________________________________________
______________________________________ ________________________________________
Number of copies to this address __________ Number of copies to this address ____________
Hand Written Signature___________________________________________
Date _____________
Federal law requires a pen to paper signature.
Transcript processing times vary based on the number of requests received daily. Requests will not be processed if
there is a Business Office hold.
OFFICE USE ONLY
Business Office Approval Date
Date sent Initials
Date ready pickup Initials
Date faxed Initials
$10 Rush Processing Requested
(processed in 2 business days)
Credit Card#: _______________________________________
CID# (3 digit security code on back): __________________
Expiration Date: ___________________
**No Charge for Regular Processing**
TRANSCRIPT REQUEST
1200 W. University Ave., Mitchell, SD 57301-4398
Phone: (605) 995-2642 Fax: (605) 995-2643
Email: registrar@dwu.edu
S:\Registrar\Masters Forms\Transcript Request Form.doc Rev. 8/16
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