To the student:
• Use a separate form for each college attended.
• Fill out the information below.
• Call the registrar of the institution(s) attended to find out the cost of an official
transcript. Faxed transcripts are not considered official.
• Sign and mail the request form with your payment to the office of the registrar
at the college or university attended.
• For a high school transcript, call the administrative office of the high school for
To the registrar:
Please send an official transcript to:
Continuing & Graduate Programs
Street, Suite 250
West Des Moines, IA 50266
Student name: ____________________________________________
Current address: __________________________________________
City: _____________________________ State: ____ Zip: _________
Home Phone: _____________________________________________
Last 4 Digits of Soc Security Number: _________ Date of birth: _______
Maiden name: _____________________________________________
Dates of attendance (if known): From: ____________ To: ___________
Name of high school attended: ________________________________
Student signature: ______________________________ Date: _______
Registrar, please enclose a copy of this form with the transcript. Thank you.