Office of the Registrar

Transcript Request form

Please mail or fax this completed form along with a photo copy of your drivers license or other official identification to:

Missouri Southern State University, 3950 E Newman Road, Joplin MO 64801

FAX 417.625.3117

DATE: ______________________________

STUDENT ID (SSN)___________________

PRINT NAME ________________________

SIGNATURE _________________________

OTHER LAST NAMES _________________

____________________________________

CURRENT ADDRESS

_______________________________________
_______________________________________
CITY_________________ST____ZIP________

PHONE _______________________________

MSSU graduation date ____________________

Number of transcripts needed_______

Transcript Type: (circle one) Undergraduate or Graduate

Please circle applicable items below:

Send after grades are posted

Send after degree is posted

Send now to the address below:

**This form will be made available in alternate formats upon request. Please contact Sandy Sparks at 625-9515 if you need assistance.**