Alumni Transcript Request Form

Under the Buckley-Pell Amendment to the Family Education Rights and Privacy Act of 1974 (FERPA), no personal information may be transmitted without your consent. Please complete this form and submit it to the Office of Student Services.

(Please Print)
_____________________________________
Date
_____________________________________
Campus/Center Attended
_____________________________________
Name Under Which You Attended
_____________________________________
Dates of Attendance
_____________________________________
Address
_____________________________________
City, State, Zip
_____________________________________
Date of Birth
_____________________________________
Social Security Number
_____________________________________
Graduation Date

I hereby authorize and request Mississippi Gulf Coast Community College to release my:

(Please check one)
___ Official Transcript
___ Unofficial Transcript

(Please check one)
___ Please mail this transcript.
___ Please fax this transcript.
___ I will pick up this transcript.

RECIPIENT INFORMATION:
_____________________________________
College/School/Business/Home Address
_____________________________________
Attention
_____________________________________
Street Address
_____________________________________
City, State, Zip
_____________________________________
Fax Number (If fax service requested)
_____________________________________
Student’s Signature
_____________________________________
Date

The fee for a faxed transcript is $3.00. Please make payment at the Business Office at one of the MGCCC Campuses.