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Get DSCC Transcript Request Form

DYERSBURG STATE COMMUNITY COLLEGE Transcript Request Form 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 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 Number of transcripts requested Check if Appropriate Mail transcript now. I will pick up transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Hold transcript for the current term s grades. Release Academic Transcript to Name/Address if different from above Individual s Name or Specific Office if applicable Business or Institution City State Zip Signature Required Date. 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 Number of transcripts requested Check if Appropriate Mail transcript now. 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 Number of transcripts requested Check if Appropriate Mail transcript now. I will pick up transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Hold transcript for the current term s grades. I will pick up transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Hold transcript for the current term s grades. Release Academic Transcript to Name/Address if different from above Individual s Name or Specific Office if applicable Business or Institution City State Zip Signature Required Date. 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 Number of transcripts requested Check if Appropriate Mail transcript now. I will pick up transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Hold transcript for the current term s grades. 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 Number of transcripts requested Check if Appropriate Mail transcript now. I will pick up transcript at the DSCC One Stop Center on the Dyersburg Campus. Allow 3 5 days for processing* Hold transcript for the current term s grades. Release Academic Transcript to Name/Address if different from above Individual s Name or Specific Office if applicable Business or Institution City State Zip Signature Required Date. .

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