Stark State College

Gateway Student Services

  • 6200 Frank Ave NW, North Canton, OH 44720
  • 494-6170 | Fax-(330) 966-6598
  • www.starkstate.edu | studentservices@starkstate.edu

OFFICIAL TRANSCRIPT REQUEST Akron School of Practical Nursing Please print in blue or black ink only

Student name

Date of Birth _____

Last 4 Digits of SSN ___

Former Name(s) ___

For SSC Students: Name changes require documentation (i.e. Social Security card, driver's license, legible court documentation)

Current Address ___

City, State, Zip Code ___ County ___

Telephone Number ___

BOX A Email transcript to:BOX B Mail transcript to:
Name:Name/Institution:
Email:Address:

I hereby authorize Stark State College to release my Akron School of Practical Nursing academic transcript. Photo ID required for pick-up.

Student Signature ___ Dat

Date

10000000000000000001

1000000000000000001

1000000000000000001

1000000000000000001

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FOR OFFICE USE ONLY

Processed Date _____ Initials _____