FAX: 573‐884‐9665 303 Townsend Hall

Toll Free: 855‐256‐4975 Columbia, MO 65211

High School Transcript Request Form

Complete all applicable fields, typing or writing legibly; failure to do so will result in processing delays. Your written signature (and
parent/guardian signature if under 18 years of age) is required. Courses are reflected on transcripts 7 days after completion of the final exam.
Upon receipt of this request, allow 7-10 days for processing and additional shipping time. For quicker shipping, contact Student Support
Services at (855) 256-4975 for expedited overnight shipping and additional fee information.

Student Name: Nguyen Vuong Khai An DOB: 07/27/2006 Enrollment Status:

Last First Middle Date of Birth MM/DD/YYYY Current Student
Cre Student Signature Date Parent Signature (if student is under 18) Date
Are you an NCAA or NAIA Student? No x Yes – Athlete’s ID #: x Grad ‐ Mizzou Academy
Non‐Graduate
Current contact information: annvk18012@ivy.edu.vn (+84) 774 799 875
Withdrawing from
Student Email Student Phone Number diploma program

Recipient #1 Information Recipient #2 Information

Colgate University
Recipient Name #1 Recipient Name #2

13 Oak Drive
Address Address

Hamilton New York 13346 United States

City State Zip Country City State Zip Country

admission@colgate.edu
Email Address * or FAX (Area Code) + Number Email Address * or FAX (Area Code) + Number

Please indicate format transcript should be sent in: Please indicate format transcript should be sent in:

x Electronic * USPS/Air Mail (Domestic/International) Electronic * USPS/Air Mail (Domestic/International)

To have transcripts sent to more than two recipients, complete an additional separate form.

PAYMENT INFORMATION TRANSCRIPT REQUESTS ACCEPTED BY:

(One complimentary request per academic year, begins in July)

PROCESSING FEES – per box checked above (Electronic*/Mail) Email: Fax:

$10 Domestic $15 International mizzouacademy@missouri.edu 573‐884‐9665
SELECT METHOD OF PAYMENT
Check/Money Order x Fee on Student’s Account Mail:
Mizzou Academy
01
Number of Electronic Transcripts _______ 10
x _______ 10
_______ Attn: Transcript Requests
# Requested Fee price Total
303 Townsend Hall
Number of Mailed Transcripts _______ x _______ _______ Columbia, MO 65211
# Requested Fee price Total

**Mizzou Academy no longer accepts credit card
information. All payments must be made by check/money
order or through the student’s Tiger Portal Account.
* Mizzou Academy cannot guarantee institutions will accept all
transcripts electronically. The recipient’s policies will determine if
it will be accepted as official or unofficial. Mizzou Academy’s policy
is to only send UNOFFICIAL electronic copies to any recipient that
is not part of an academic or governmental institution.

Nguyen Vuong Khai An 01/13/2024 Nguyen Thi Hai Trieu 01/13/2024

Student Signature Date Parent Signature (if student is under 18) Date

10.05.2020