APPLICATION FOR STUDENT RECORDS SERVICES
WEBSITE: www.cps.edu/studentrecords
General Information:773-553-2340
Print or type your answers to the questions on this form. Complete all fields to the best of your ability.
First item of service is free. Each additional item requires a NON-REFUNDABLE MONEY ORDER for $4.00 (no cash or personal checks), payable to the Chicago Public Schools, along with a self addressed envelope to one of the addresses listed below depending on the year requested:
IF YOU WERE IN SCHOOL FROM 1989 TO THE PRESENT PLEASE FAX TO: 773-553-2341
OR MAIL TO: CHICAGO PUBLIC SCHOOLS OFFICE OF COMPLIANCE
125 S. CLARK STREET, 11TH FLOOR CHICAGO, IL 60603
*Turn around time is 2 - 3 business days from time we receive your request /Allow extra time to receive via US mail
IF YOU WERE IN SCHOOL BEFORE 1989 PLEASE FAX TO: 773-535-5894
OR MAIL TO: CHICAGO PUBLIC SCHOOLS STUDENT RECORDS SERVICES 3532 W. 47TH PLACE, 1ST FLOOR
CHICAGO, IL 60632
*Turn around time is 5 -7 business days from time we receive your request /Allow extra time to receive via US mail
~~NO WALK-IN SERVICE AVAILABLE AT EITHER LOCATION~~
1.What is your present name and address?
Name: __________________________________________________________________________________________
Address: __________________________________________________________________________________________
|
(Number) |
(Street) |
(City) |
|
_________________________________________________________________________________________________________________ |
|
(State) |
(Zip Code) |
(Telephone) |
2. |
Is this request for information for yourself? |
_____ Yes |
_____ No |
If no, provide the name of the person (applicant) for whom the information is being sought and designate your relationship with the person.
Name: ____________________________________________________________________________________
Relationship: _______________________________________________________________________________
3.What is the purpose of this request? (1st request is FREE, each additional is a $4.00 Money Order )
___ Verification of Birth (for I.D.) |
___ Verification of Graduation |
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___ Day ___ Summer ___ Evening |
___ Request for Elementary Records |
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|
___ Request for High School Transcripts |
___ Immunization Records (Only 27 years of age or younger) |
___ Day ___ Summer ___ Evening |
4.Background Information:
A. What name did the applicant use while attending school? (List all possible names below)
________________________________________________________________________________________
B. (Check One) _____ Male _____ Female Is this your first request? (Check One) _____ Yes _____ No
C. Where was the applicant born? ____________________________________________________________
D.What is the date of birth? ________________________________________________________________
(MM/DD/YYYY)
E.What are the names of the applicant’s parents or custodian? _____________________________________
F.What is the mother’s maiden name? ________________________________________________________
Complete the following information pertinent to the Chicago Public Schools attended by the applicant.
Name(s) of Elementary School(s) |
Year Left/ Graduated |
______________________________________ |
_____________________________________ |
______________________________________ |
_____________________________________ |
______________________________________ |
_____________________________________ |
Names(s) of High School(s) |
Year left / Graduated / Evening School |
_____________________________________ |
____________________________________ |
_____________________________________ |
____________________________________ |
_____________________________________ |
____________________________________ |
Conditions:
A.Records information will not be released to anyone other than the former student who request
records information unless (a) the former student signs a release authorizing the transmittal of information (see below) or (b) a subpoena or court order is received in due form.
B.A college or university does not usually recognize transcripts unless they are mailed directly to the college or university by the local education agency (this office). Should you desire that a transcript be sent directly to you, our office will comply with your request, but the college or university for whom it is intended may not accept it.
5.Release Form:
Iauthorize the records custodian of the Chicago Public Schools to provide the information requested above and mail or fax it to:
______________________________________________________________________________________
(Name)
____________________________________________________________________________________________________________
(Address)
____________________________________________________________________________________________________________
(City) |
(State) |
(Zip Code) |
_______________________________________________ |
_____________________________________________ |
(Signature of Applicant) |
(Date) |
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