Fillable Transcript Request Form (Dickinson State University)

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Transcript Request Form (Dickinson State University)

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The Transcript Request Form (Dickinson State University) form is 2 pages long and contains:

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One Stop Use: Date Sent: _______________ Sent By: _______________________
Dickinson State University, 291 Campus Drive, Dickinson, ND 58601
dsu.onestop@dickinsonstate.edu
701-483-2090
Transcript Request Form
There is a fee of $8.25 per transcript. This fee applies to all transcript requests, including those you pick up at
our office. If you have a financial obligation to Dickinson State University, official transcripts will not be printed.
Dickinson State University students do not need to request and will not be charged for official
transcripts to be sent to other North Dakota University System (NDUS) institutions for admission
purposes. The NDUS college or university to which you have applied will be able retrieve your academic
transcript from other NDUS colleges and universities. You will be notified if you have any holds on your
academic transcripts for outstanding debt owed to a NDUS college or university.
If you will be mailing this form to the DSU One Stop, be sure to include your personal check for the correct
amount. If you wish to pay by credit card, follow the directions at the end of this document.
Date of Request ______________________________________________ Phone Number __________________________________________
Last Name ____________________________________________________ First Name _______________________________________________
Former Last Name(s) ____________________________________________________________________________________________________
Student ID# ____________________________________________ Social Security Number _______________________________________
Your Address _____________________________________________________________________________________________________________
Email Address ____________________________________________________________________________________________________________
Dates you attended DSU: FROM ____________________________________/ TO _____________________________________________
Please print transcript: ______________ Immediately
______________ At the end of the term after grades have been posted
______________ After degree is posted
__________ No, I will pick up on ____________________________________________________________________________________________
__________ Yes, please mail my transcript to the entities listed on the back side of this form.
Student Signature: ___________________________________________________________________________
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signature
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One Stop Use: Date Sent: _______________ Sent By: _______________________
Dickinson State University, 291 Campus Drive, Dickinson, ND 58601
dsu.onestop@dickinsonstate.edu
701-483-2090
SEND MY TRANSCRIPT TO:
($8.25 for Each Transcript Requested)
NOTE: One copy will be sent to each address listed below:
University/Company/Name: ________________________________________________________________________
Address: _______________________________________________________________________________________________
Address: _______________________________________________________________________________________________
City/State (Foreign Country)/Zip: ___________________________________________________________________
___________________________________________________________________________________________________________
University/Company/Name: ________________________________________________________________________
Address: _______________________________________________________________________________________________
Address: _______________________________________________________________________________________________
City/State (Foreign Country)/Zip: ___________________________________________________________________
___________________________________________________________________________________________________________
University/Company/Name: ________________________________________________________________________
Address: _______________________________________________________________________________________________
Address: _______________________________________________________________________________________________
City/State (Foreign Country)/Zip: ___________________________________________________________________
___________________________________________________________________________________________________________
CREDIT CARD ORDERS
If you intend to pay the transcript processing fee with a credit card, you must:
1. Print this form
2. Fill it out and immediately fax to 701-483-2409 or email to dsu.onestop@dickinsonstate.edu
3. Telephone the DSU One Stop at 701-483-2090
4. Give them your name, credit card number, expiration date and the “V” code number located on
the back of the card
5. Your credit card will be charged the appropriate processing fee and your transcript request will
be processed
6. Do not indicate your credit card information on this form!
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Transcript Request Form (Dickinson State University)

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Completed 19 August 2020

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