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					                          Kirksville R-III school District
                          Official Transcript Request Form

       Complete this form and return to the address below
       The cost is $3.00 per transcript (check/money order made payable to:
                 Kirksville R-III School District
     Upon receipt of fee, an official copy of your transcript will be
        ready for Pickup/US Mail/Fax to the provided address
       Federal express, credit cards, special mailings, or rushes are not
        available
           Mail form to:          Kirksville R-III School District
                                  Transcripts
                                  1901 E Hamilton
                                  Kirksville, MO 63501-3904

Today’s Date: ___________Yr. of Graduation:______ or Yr. in School:_______

Name: _______________________________________________________________
         Last (Name while enrolled)            First         Middle
Home Address:____________________________ Phone/Cell: ________________

City: ___________________________ State:___________Zip code:____________

Reason:         College                Job             Personal   (Circle one)
Please forward a copy of my transcript to the following address:

        College or Company__________________________________

        Address: _____________________________________________

        City, State, Zip:________________________________________

Signature (Required): ______________________________________
Jane Schaper, June 2009




(Federal Express, credit cards, other special mailings, and rushes are not available; $3.00 fee is per
copy)

				
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posted:9/29/2012
language:English
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