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Transcript Req Form

The form requests applicant information like name, date of birth, previous school attended, and contact details. It also requests distribution information for where the transcript should be sent. The applicant must provide a signature to authorize the release of the transcript. Payment of $20 for the first two copies and $5 for additional copies is required.

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mrmynx
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
12 views

Transcript Req Form

The form requests applicant information like name, date of birth, previous school attended, and contact details. It also requests distribution information for where the transcript should be sent. The applicant must provide a signature to authorize the release of the transcript. Payment of $20 for the first two copies and $5 for additional copies is required.

Uploaded by

mrmynx
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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HALTON DISTRICT SCHOOL BOARD REQUEST FOR TRANSCRIPT Authorization and Consent

Transcript Fee: $20.00 for the first 2 copies, $5.00 for each additional copy. NOTE: Your transcript request will NOT be processed until receipt of this completed form with the applicable non-refundable fees and a copy of photo id showing your date of birth. Please allow one week for processing.

APPLICANT INFORMATION (Please Print)


Last Name: Last/Family Name: (while in school) First Name: Other Names Used: Middle Name: Gender: M F Date of Birth:
(year/month/day)

Last Secondary School Attended:

Last Year of Attendance:

HDSB Student Number: (if known)

OEN Ontario Education Number: (if known)

Current Mailing Address:

City/Country:

Postal Code:

Home: ( Bus: ( Fax: ( E-Mail:

) ) )

Reason for Request: University College Re-entry Employment Other (Please specify):

DISTRIBUTION INFORMATION
No. of Transcripts Required:

(Please Print) Date:

I, the undersigned do hereby authorize the Halton District School Board to release a copy of my student transcript(s) as indicated below: Signature:

PICKUP By Applicant By Other: Indicate Full Name of Authorized Person Additional Comments:___________________________________ _____________________________________________________

MAIL OR FAX To Applicant (at address indicated above) To Other: (if mailing to more than one location, provide details reverse)

Name

Mailing Address Applicant will be notified when transcript is available for pick up. Two pieces of identification must be presented to obtain OST. City Date OST Received: ___________________________________ Fax #: Signature: ___________________________________________ Post-Secondary Ref. No (if applicable) ______________________ Prov. Postal Code

FOR OFFICE USE ONLY (To be completed by Office Personnel)


Payment received: Amount: $_______

Cash
Historical Money Order

Proof of identity received/confirmed

Signature of Office Personnel Source of Information for Transcript: Production OSR Service Desk Ref. #: Completed by: Date prepared:

Revised: 07/20/06

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