(Two FREE lifetime requests)
Submit completed form by email to MJCESeforms@mjc.edu by fax or mail to Enrollment Services.
Transcript Request
You are eligible for two FREE lifetime ocial transcripts as a MJC student. If you have used your two FREE lifetime
requests or would like to order transcripts by rush go online to www.studentclearinghouse.org. When submitting this
form using a personal email, please sign in blue or black ink. We are currently processing as quickly as possible, but
due to COVID-19 we are only able to go on campus to process once every two weeks. Please expect a delay.
Student Information:
First Name: Middle Initial: Last Name:
Student ID/Last 4 SSN: Birthdate: Phone:
Previous Names Used on Academic Records (if any):
Mailing Address: City: State: Zip:
MJC Email:
Number of Ocial MJC Transcript Copies Requested:
Check Only ONE Box for Type of Delivery:
Mail to address listed above (SELF)
Mail to alternative address listed below:
College Name or Business:
Attention To:
Mailing Address:
* For CSU GE/IGETC Certication Request, please complete the CSU GE/IGETC Form.
By signing below, I certify under penalty and perjury I am the student listed above and understand I am using one
of my free ocial transcript requests. If any information is incomplete or incorrect, I understand it may delay the
processing time.
Student Signature: Date:
OFFICE USE ONLY
Posted By: Processed By:
Posted Date: Processed Date:
1st Free 2nd Free Received by MJC Student Email
MJC Enrollment Services • Phone (209) 575-6853 • Fax (209) 575-6859
EAST 435 College Avenue, Student Services Bldg. 1st Floor • WEST 2201 Blue Gum Avenue, Yosemtie Hall 1st Floor
06/2020_SJB
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