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YOUR INFORMATION
NOTE: Name change requires documentation. Copy of social security card, driver's license, or marriage certificate
Last Name:
First Name: Middle Initial:
Maiden/
Former Name:
Current Address:
(please include City, State and Zip)
Social Security: Phone Number:

I hereby authorize Stark State College of Technology to release my academic transcript.

____________________________________________________________
(Signature)
 
MAIL TRANSCRIPT TO:
Last Name:
First Name: Middle Initial:
Address:
(please include City, State and Zip)
Mail transcript immediately Will pick up transcript Mail transcript when term ends