DIXIE STATE COLLEGE OF UTAH

Transcript Request Form

 

  1. Complete form online – then print out.  Incomplete forms will not be accepted.
  2. If faxing, send to (435) 656-4005.
  3. If mailing, send to: Dixie State College, Registrars Office, 225 South 700 East, St. George, UT.  84770
  4. If credit card information is not included, send either check or money order.
  5. Fees:  Official Transcript - $4.00, Unofficial Transcript - $1.00, To have it faxed – Additional $5.00

                  For overnight service – Additional $20.00 (must be requested prior to 12:00 p.m., and must provide street address

                  (no P.O. Box) and Phone Number of recipient.

  1. Transcript requests will not be processed without accompanying payment.
  2. Students who have past-due balances will not be issued transcripts (contact Cashier’s Office, (435) 652-7605).

 

The following information can be completed online (tab between entries)

 

Last Name:  ________________________________________     First Name:  ___________________________________________

 

Maiden Name:  ________________________     Social Security Number:  ___________________   Date of Birth:  ______________

 

Phone Number:  (          )  _________________   Attended from (indicate 1st year):  _________    To (most recent year): __________

 

How many official transcripts?:  ____     How many unofficial transcripts:  ____   Hold for grades? ______  Hold for degree?  _____

 

E-mail address:  ______________________________________     Signature:  ___________________________________________

 

Mailing information:  (if more than 3 addresses, add an additional sheet):

Text Box:   Name/Institution:  ___________________________________________    Contact Name:  ____________________________   Address Information:  ____________________________________________________________________________________     City:  __________________________________________  State: ________________   Zip: __________________       Text Box:   Name/Institution:  ___________________________________________    Contact Name:  ____________________________   Address Information:  ____________________________________________________________________________________     City:  __________________________________________  State: ________________   Zip: __________________       Text Box:   Name/Institution:  ___________________________________________    Contact Name:  ____________________________   Address Information:  ____________________________________________________________________________________     City:  __________________________________________  State: ________________   Zip: __________________      

 

Or fax to:  ____________________________________________     Attn:  ______________________________________________

 

Credit Card Information (Secure transaction – Master Card, Visa, or Discover)

 

Card Number:  ______________________________________    Expiration Date:  _______________________________

 

Card Holder Name:  ___________________________________________     Zip Code of Card Holder:  _____________