Request for Transcript
There is no charge for transcripts which are sent via regular mail. However, there will be a $10 special handling fee for any transcript requested to be faxed. Dickinson State University cannot guarantee the print quality of a faxed transcript.  No refunds will be made because of print quality.
Date: ________________  
Student ID #: ________________
Social Security #:
___________________
Name: __________________________________  
Former Name(s): __________________________________             __________________________________

Address:

 __________________________________
City/State: __________________________________  Zip: _______________
Phone#: ________________
E-mail:_______________________________
Dates of attendance at Dickinson State University _______________________________
Official Un-Official
Where would you like your transcript to be sent?
Multiple copies of transcripts may be requested on this form for third party recipients (colleges, agencies, etc.) However, students may request only one (1) transcript to be sent to themselves per each request form submitted.
Name/Company: ________________________________________

Address:

________________________________________
  ________________________________________
City/State: ________________________________________
Zip: ________________________________________
Phone#: ________________________________________
Name/Company: ________________________________________
Address: ________________________________________

 

________________________________________
City/State: ________________________________________
Zip: ________________________________________
Phone#: ________________________________________

There is no charge for transcripts which are sent via regular mail. However, there will be a $10 special handling fee for any transcript requested to be faxed. You must include a valid credit card number on this request. Dickinson State University cannot guarantee the print quality of a faxed transcript.  No refunds will be made because of print quality.

Only the following cards are accepted:  VISA   MASTERCARD   DISCOVER

Card Number:

 ____________________
Expiration Date ____________________
Three digit “V” Code: ____________________ (Number on back of the card.)
Fax Number: ____________________
   
Signature__________________________________________________________
You may fax or mail this request to:
FAX: (701) 483-2409 Office of Academic Records
Dickinson State University
291 Campus Drive
Dickinson, ND 58601