Transcript Request Form

Moberly Area Community College
Office of Admissions and Records
101 College Avenue
Moberly, MO 65270
1-660-263-4110 or 1-800-MACC-070 (1-800-622-2070)
Fax: 1-660-263-2406 or E-Mail address: regist@macc.edu

There is no charge to have a transcript mailed up to 5 per 1 request. There is a $6.00 fax fee.

1. Semester and year last enrolled: Fall Spring Summer        Year

2. Student ID # or Social Security Number:

3. Date of Birth (mm/dd/yyyy): //

4. Legal Name: Last Name, First Name Middle Name

5. Other Name/s under which your records may be located (i.e. maiden name):
            Other Name: Last Name, First Name Middle Name

6. Legal Address (Permanent):

Street:    City:
State:    Zip+4:    Country:
E-Mail: (If applicable.)
Phone: --

7. Transcript Type Requested.       Official Unofficial
Recipient Name
Address           
City, State ZIP

8. Transcript Type Requested.       Official Unofficial
Recipient Name
Address           
City, State ZIP


9. No. of Transcripts Requested (5 Maximum):

10. Please delay mailing transcript until grades for the current semester are posted.   Yes No

Your signature below authorizes MACC to release a copy of your record to the recipient shown on this form. It will take up to 5 working days for a transcript to be processed. No transcript will be furnished when Financial Aid, Student Services, Business Office or Library obligations have not been satisfied. Federal law prohibits release of this transcript or its contents to any party without the written consent of the student.

10. Signature_________________________________________ Date________________

11. Special Instructions: Fill in requested information, then print a copy of this page, sign and date, then either mail, email or fax this page to MACC as listed at top of form.

7/6/2016