STUDENT TRANSCRIPT REQUEST FORM

To request a transcript, provide this signed form to:

MESA International

ATTN: GEP Registrar

107 S. Southgate Dr.

Chandler, AZ 85226 USA

Fax to +1 (480) 893-7775 or email to .

Official transcripts will not be issued until all financial obligations to the MESA Global Education Program have been met.

Last Name on record, First Name / Email Address
Organization / Telephone
Current Mailing Address
City / State/Province / Country / Postal Code
Program(s) Completed through MESA GEP / Date(s) Attended
I certify that I am the person whose name appears on the lines of this form, and do hereby authorize release of my record with the MESA Global Education Program to the address listed above. Student academic records are classified as confidential and may be released only with the student's written authorization and signature.
Signature / Date:

STUDENT TRANSCRIPT REQUEST FORM (Continued)

There is no charge for an email copy of your transcript. Please check the following box if you are requesting an email copy of your transcript:

Yes, please send an email copy to the address provided above.

Your transcript will be emailed to your attention at the address provided on this Student Transcript Request Form within Seven (7) Business Days of the date that you submitted your .

The following charges in US Dollars are applicable if you require that a Transcript be mailed to you:

$10.00 per location for MESA to mail the transcript mailed within the Continental US, within seven (7) days of receipt of request.

$25.00 per location for MESA to provide Expedited Mailing within the Continental US, within 3 days of receipt of request.

$75.00 per location for MESA to Expedite International Mailing (delivery 3-5 days)

Number of copies to this address: Number of copies to this address:

Recipient / Recipient
Physical Street Address / Physical Street Address
City, State/Province, Postal Code, Country / City, State/Province, Postal Code, Country
Phone Number / Phone Number
Make all checks payable to:
MESA International
107 S. Southgate Drive
Chandler, AZ 85226-3222
Card Type: VISA MasterCard Discover AMEX
Credit Card Number: / Exp. Date:
Cardholder’s Address: / CCV Code:
Cardholder’s City, Country:
Authorized Signature:
If you have any questions concerning this invoice, contact: Registration Assistance at +1 480 893-6883 or
Please fax a copy of this invoice with your payment information to +1 480 893-7775.

MESA International

107 South Southgate Drive

Chandler, AZ 85226 USA

Phone: +1-480-893-6883 / Fax: +1-480-893-7775

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