IS-10-C
TRANSCRIPT REQUEST FORM
TRANSCRIPT FEE: $15.00 for the first copy, $5.00 for each additional copy, to a maximum of $20.00.
Note: Your transcript request will be processed within 48 hours of receipt of this completed form, as well as the applicable non-refundable
fee(s) and photo ID containing your name and date of birth.
APPLICANT INFORMATION (Please Print)
Last Name:
First Name:
Last Name: (while in school)
Other Names Used:
Middle Name:
Gender:
Date of Birth:
(year/month/day)
Last Secondary School Attended:
Current Mailing Address:
Last Year of Attendance:
OEN Ontario Education Number: (if
known)
WRDSB Student Number:
(if known)
City/Country:
Postal Code:
Home: ( )
Bus: ( )
Fax: ( )
E-Mail:
Reason for Request:
University
College
Re-entry to
Secondary School
Employment
Other (Please specify):
______________________________________
DISTRIBUTION INFORMATION (Please Print)
Number of Transcripts
I, the undersigned do hereby authorize the Waterloo Region District School Board to release a copy of
Required:
my student transcript(s) as indicated below:
Date:
Signature:
PICKUP
MAIL OR FAX
By Applicant
To Applicant (at address indicated above)
By Other:
To Other: (if mailing to more than one location,
provide details on reverse)
(indicate Full Name of Authorized Person)
Additional Comments:
Name
Applicant will be notified when transcript is available for pick up.
Photo ID must be presented to obtain Transcript.
Mailing Address
Date OST Received: ___________________________________
City
Province
Postal Code
Fax #:
Signature: ___________________________________________
Post-Secondary Ref. No (if applicable) ______________________
FOR OFFICE USE ONLY (To be completed by Board Staff)
Payment received:
Proof of identity received/confirmed
Amount: $_______________________
Signature of Office Personnel
Cash
Money Order
Date:
During the school year, please return this completed form to your last WRDSB secondary school. During the summer, or if your secondary school is closed, please send it to the following
address (along with the appropriate money order and a photocopy of your photo ID): Melanie Maar, Waterloo Region District School Board, 51 Ardelt Avenue, Kitchener, ON N2C 2R5.
The information collected on this form is subject to the Municipal Freedom of Information and Protection of Privacy Act. Questions about the collection of this personal information should be
directed to the Freedom of Information, Privacy and Records Information Management Officer, Waterloo Region District School Board.