Office of the Registrar

2900 University Avenue

Crookston, MN 56716-5001

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Official Transcript Request Form

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Name:
	(last)	(first)	(middle)	(maiden)

Student ID Number: Social Security Number:

Address:

City: State: ZIP/Postal Code:

Telephone Number:

Last Quarter/Semester and Year of Attendance at UMC:

Number of Transcripts Requested:

Official Copy ($5.00 for each requested)

Student Copy (no charge)

Address to send transcript:

Name:
Address:
City:	State: , Zip:

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Signature                                           Date

For Office Use Only

Date Sent: _____________

Sent By: _______________

Paid: _________________

The University of Minnesota is an equal opportunity educator and employer.