Are you currently enrolled? If not, last date attended?
Campus last attended? Jackson County Campus Jefferson Davis Campus Perkinston Campus
George County Center Keesler Center West Harrison County Center
Community Campus/Advanced Manufacturing and Technology Center
Were you enrolled prior to Fall 1979? Yes No
Birth Date: Social Security Number:
Send Transcript to:
(Please print plainly)
Number of copies to above address (or) Will pick up
Hold for current semester grades (or) Send immediately
Please print current name
Former or Maiden Name
Please list any other name(s) under which you might have attended:
I understand that, pursuant to rights contained in the Family Education Rights and Privacy Act of1974, any information
released to the above institution or individual will not be released to any other party without the written consent of the above named
I have been given the opportunity to challenge the contents of my school records to insure that the school records are not
inaccurate, misleading or otherwise in violation of my privacy or other rights and have been provided an opportunity for the
correction or deletion of any such inaccurate, misleading, or otherwise inappropriate data contained therein.
TRANSCRIPTS ARE FREE. FAXED COPIES ARE $3.00 EACH.
Date Issued: Paid:
PLEASE READ CAREFULLY!
If your record has been encumbered by financial indebtedness or admission requirements have not been met, no transcript can be issued until
the obligation has been cleared.
High School transcripts CANNOT BE RELEASED by this office. Please contact your high school.
TRANSCRIPTS FROM OTHER COLLEGES or UNIVERSITIES that have been sent to our office for our files CANNOT BE COPIED. Additional
copies must be obtained directly from the schools.
Students’ records are confidential and transcripts are issued only at the written request of the student.
Community Jackson County Jefferson Davis Keesler AFB West Harrison Perkinston George County
Campus Campus Campus Center County Center Campus Center
Advanced Admissions/Records Admissions/Records Admissions/Records Admissions/Records Admissions/Records Admissions/Records
Manufacturing & Office Office Office Office Office Office
Technology Center POB 100 2226 Switzer Road POB 5008 21500 B Street POB 548 POB 77
10298 Express Drive Gautier, MS 39553 Gulfport, MS 39507 Biloxi, MS 39534 Long Beach, MS 39560 Perkinston, MS 39573 Lucedale, MS 39452
Gulfport, MS 39503 228/497-7639 228/896-2500 228/432-7198 228/868-6057 601/928-6206 601/947-4201
228/897-4360 Fax: 228/497-7873 Fax: 228/897-3921 Fax: 228/435-1542 Fax: 228/868-6060 Fax: 601/928-6345 Fax: 601/947-4899
SSADM10 (R 6/09)
Mississippi Gulf Coast Community College is an Equal Opportunity Employer and welcomes students and employees without regard to race, color, religion, national origin, sex, age or qualified disability. For further information, contact
the Equal Opportunity Officer at a Mississippi Gulf Coast Community College Center, Campus, or the Central Office. Compliance is coordinated by the Vice President for Administration and Finance, Perkinston Campus, P. O. Box 609,
Perkinston, Mississippi 39573, telephone number 601-928-5211.