The School Board of Broward County
Records Retention
Transcript Request
7720 W. Oakland Park Blvd., 3rd Floor
Sunrise, FL 33351
Instructions: This form is for students requesting transcripts from 7 years ago and prior. If you attended within the last 7 years, contact your last school. Mail this form and copy of identification to Records Retention, to address shown above. Transcript fee for each copy is $3.00 for official (College, Employment, SS, etc.) OR $7.00 for certified (Immigration, Subpoenas, etc.), cash or money order only made to: The School Board of Broward County. No personal checks accepted. All request received incomplete or
unacceptable will be returned immediately. |
Check one: |
|
OFFICIAL ___ CERTIFIED___ |
*This form is not for GED request.
*Student Name _______________________________________ *DOB ____________________
Married/Other Name ___________________________________ SSN ____________________
*Home Phone ______________________ Work _______________ Cell ____________________
E-Mail Address _________________________________________ *Number of Copies: _______
*Last public BROWARD County school(K-Votech) ______________________________________
*Last year in school __________ Did you graduate? Yes OR No If no, last grade attended______
Program Title (if applicable)__________________Attendance Dates _________________________
Did you complete the tech program? Yes or No, $3 Elem___$3 Middle___$3 High___$3 Tech__
Mail to:
Name ________________________________________________________________________
Address_______________________________________________________________________
______________________________________________________________________________
City _________________________________State___________ Zip _______________________
Mail to:
Name ________________________________________________________________________
Address_______________________________________________________________________
______________________________________________________________________________
City _________________________________State___________ Zip _______________________
Authorization Statement and Authorized Signature
I certify, under penalty of perjury, pursuant to Florida Statute Section 92.525, that I am the former student requesting my records. I hereby authorize the release of records or information as instructed above.
*Student INK Signature __________________________________________________________
Date__________________ |
ATTACH PHOTO ID BEFORE MAILING |
*REQUIRED |
Form 4191A
REV 08/19
Records Retention
