Transcript Request Form

Student's Name (Maiden, if applicable) *

First

Last

Email *

Please use an email address that is checked frequently, in case there are questions about your order.

Phone Number

Address *

Please include the student's FULL address (street, city, state, zip)

Graduation Year *

Multiple Transcripts to ONE Address -

Separate Envelopes?

Check here if you need the transcripts below mailed to THE SAME ADDRESS and each must be in a separate, sealed envelope and stamped across the envelope seal. This is usually done when hand-carrying transcripts to several colleges. If this is not checked, and you order multiple transcripts sent to THE SAME ADDRESS, then the transcripts will all be included in one envelope.

How many transcripts do you wish to order? *

Up to 4 transcripts may be ordered on this form.

Name of College or Other Institution - 1

If you are a parent or graduate and wish to order a transcript for yourself, enter your name here. NOTE: PARENTS AND/OR GRADUATES MUST ORDER A MAILED TRANSCRIPT. MDHSA only emails transcripts to colleges or other educational institutions.

Street Address

You do not need to fill out this field if you wish your transcript to be emailed.

City, State, Zip Code

You do not need to fill out this field if you wish your transcript to be emailed.

Email

You do not need to fill out this field if your transcript will be mailed.

I would like this transcript sent via:

Mail
Email

Select one.

Name of College or Other Institution - 2

If you are a parent or graduate and wish to order a transcript for yourself, enter your name here. NOTE: PARENTS AND/OR GRADUATES MUST ORDER A MAILED TRANSCRIPT. MDHSA only emails transcripts to colleges or other educational institutions.

Street Address

You do not need to fill out this field if you wish your transcript to be emailed.

City, State, Zip Code

You do not need to fill out this field if you wish your transcript to be emailed.

Email

You do not need to fill out this field if your transcript will be mailed.

I would like this transcript sent via:

Mail
Email

Select one.

Name of College or Other Institution - 3

If you are a parent or graduate and wish to order a transcript for yourself, enter your name here. NOTE: PARENTS AND/OR GRADUATES MUST ORDER A MAILED TRANSCRIPT. MDHSA only emails transcripts to colleges or other educational institutions.

Street Address

You do not need to fill out this field if you wish your transcript to be emailed.

City, State, Zip Code

You do not need to fill out this field if you wish your transcript to be emailed.

Email

You do not need to fill out this field if your transcript will be mailed.

I would like this transcript sent via:

Mail
Email

Select one.

Name of College or Other Institution - 4

If you are a parent or graduate and wish to order a transcript for yourself, enter your name here. NOTE: PARENTS AND/OR GRADUATES MUST ORDER A MAILED TRANSCRIPT. MDHSA only emails transcripts to colleges or other educational institutions.

Street Address

You do not need to fill out this field if you wish your transcript to be emailed.

City, State, Zip Code

You do not need to fill out this field if you wish your transcript to be emailed.

Email

You do not need to fill out this field if your transcript will be mailed.

I would like this transcript sent via:

Mail
Email

Select one.

Transcript Request Fees *

1 transcript ordered - $ 5.00
2 transcripts ordered - $ 10.00
3 transcripts ordered - $ 15.00
4 transcripts ordered - $ 20.00

Total

$ 0.00

OPTION 1: PRINTABLE TRANSCRIPT REQUEST TO BE MAILED WITH CHECK OR MONEY ORDER

OPTION 2: ONLINE FORM
By completing the form below and submitting payment, you are authorizing MDHSA to release your records to the listed institutions.

OPTION 1: PRINTABLE TRANSCRIPT REQUEST TO BE MAILED WITH CHECK OR MONEY ORDER

OPTION 2: ONLINE FORM By completing the form below and submitting payment, you are authorizing MDHSA to release your records to the listed institutions.

OPTION 2: ONLINE FORM
By completing the form below and submitting payment, you are authorizing MDHSA to release your records to the listed institutions.