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Get Dyersburg State Community College Transcript Request Form

COMPLETE THIS FORM ONLY IF YOU ARE REQUESTING YOUR DYERSBURG STATE COMMUNITY COLLEGE TRANSCRIPT Please complete all information and FAX completed form to 731/286 3325 or mail to Dyersburg State Community College Office of Admissions and Records 1510 Lake Road Dyersburg TN 38024 DSCC transcripts will be issued free of charge for up to six copies per term. A fee of 1. 00 will be assessed for each additional transcript. Due to the costs involved DSCC does not fax transcripts. Name and Date of Birth Last First Middle Former Name s Birth Date MM DD YY Contact Information Street Address City State Zip Email Phone DSCC ID OR Last 4 Digits of SSN Are you currently enrolled at DSCC Number of transcripts requested Check all of the following that apply to your request Mail my DSCC transcript to me at the address listed above. COMPLETE THIS FORM ONLY IF YOU ARE REQUESTING YOUR DYERSBURG STATE COMMUNITY COLLEGE TRANSCRIPT Please complete all information and FAX completed form to 731/286 3325 or mail to Dyersburg State Community College Office of Admissions and Records 1510 Lake Road Dyersburg TN 38024 DSCC transcripts will be issued free of charge for up to six copies per term* A fee of 1. 00 will be assessed for each additional transcript. Due to the costs involved DSCC does not fax transcripts. Name and Date of Birth Last First Middle Former Name s Birth Date MM DD YY Contact Information Street Address City State Zip Email Phone DSCC ID OR Last 4 Digits of SSN Are you currently enrolled at DSCC Number of transcripts requested Check all of the following that apply to your request Mail my DSCC transcript to me at the address listed above. I will pick up my DSCC transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Do not mail my DSCC transcript until the current term s grades are posted* Mail my DSCC Transcript to Name/Address Individual s Name or Specific Office if applicable Business or Institution City State Zip Signature Required Date. COMPLETE THIS FORM ONLY IF YOU ARE REQUESTING YOUR DYERSBURG STATE COMMUNITY COLLEGE TRANSCRIPT Please complete all information and FAX completed form to 731/286 3325 or mail to Dyersburg State Community College Office of Admissions and Records 1510 Lake Road Dyersburg TN 38024 DSCC transcripts will be issued free of charge for up to six copies per term* A fee of 1. 00 will be assessed for each additional transcript. Due to the costs involved DSCC does not fax transcripts. 00 will be assessed for each additional transcript. Due to the costs involved DSCC does not fax transcripts. Name and Date of Birth Last First Middle Former Name s Birth Date MM DD YY Contact Information Street Address City State Zip Email Phone DSCC ID OR Last 4 Digits of SSN Are you currently enrolled at DSCC Number of transcripts requested Check all of the following that apply to your request Mail my DSCC transcript to me at the address listed above. Name and Date of Birth Last First Middle Former Name s Birth Date MM DD YY Contact Information Street Address City State Zip Email Phone DSCC ID OR Last 4 Digits of SSN Are you currently enrolled at DSCC Number of transcripts requested Check all of the following that apply to your request Mail my DSCC transcript to me at the address listed above. I will pick up my DSCC transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Do not mail my DSCC transcript until the current term s grades are posted* Mail my DSCC Transcript to Name/Address Individual s Name or Specific Office if applicable Business or Institution City State Zip Signature Required Date.

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