Rev 04-Dec-15
REQUEST FOR TRANSCRIPT
(All transcripts must be issued to and sent directly to MGA.)
TO THE REGISTRAR OF _______________________________________________________
(Name of Institution Attended)
I, _____________________________________________, would like to request that you
(Please Print Full Name)
please send one official copy of my transcript to:
MIDDLE GEORGIA STATE UNIVERSITY
OFFICE OF ADMISSIONS
100 UNIVERSITY PARKWAY
MACON, GA 31206
*Please contact the Student listed below if additional items are required to process this request.
Current Name: ________________________________________________________________
All Previous Name(s):___________________________________________________________
Last Term Enrolled: ____________________________________________________________
Social Security Number: ________________________________________________________
Date of Birth: _________________________________________________________________
Current Address: ______________________________________________________________
______________________________________________________________
Daytime Phone Number: ________________________________________________________
Email Address: _______________________________________________________________
_________________________________________ ______________________________
Student Signature (Required) Date
