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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
1000000000000000001
FOR OFFICE USE ONLY
Processed Date _____ Initials _____