Inactive Student Records Release Of Information Form printable pdf download

Revised: 9/26/2014

San Diego Unified School District

Student Records Department

6735 Gifford Way, Room 13

San Diego, CA 92111

(858) 496-8201

Inactive Student Records Release of Information Form

The following information is required and mandatory for the release of inactive student records and/or information

by the Student Records Department.



Obtaining a Transcript: For transcripts contact the registrar at the last school you attended. Elementary,

middle, and high school transcripts can be obtained from the last school of attendance. The first two are

provided at no cost. Additional copies can be purchased for $3.00 per transcript.



For other relevant inactive student records request, fill out this form. Please include a clear copy of an

official photo identification showing a clear picture, birth date, and signature. The first two copies of inactive

student records are provided at no cost. If you need additional copies, please include a $3.00 check/money

order per copy (no cash), made payable to San Diego Unified School District or SDUSD. Send to the Student

Records Department by U.S. Mail to the address indicated above.



The Student Records Department will contact you if any additional information is needed. NO WALK-INS

CURRENT NAME (Print) ___________________________________________________________________

NAME KNOWN AS IN SCHOOL/or same (Print) _______________________________________________

DATE OF BIRTH ___________________________ PLACE OF BIRTH ____________________________

HOME ADDRESS _________________________________________________________________________

CITY ____________________________________ STATE _______________ ZIP CODE _______________

HOME PHONE ________________________________ CELL PHONE ____________________________

DRIVER’S LIC. /STATE ID/PASSPORT# __________________ EXPIRATION DATE _____________

DID YOU GRADUATE? (Yes/No) ____ SCHOOL ___________________ GRADE ____ YEAR _______

LIST ANY OTHER SAN DIEGO UNIFIED SCHOOLS YOU ATTENDED

GRADE

YEAR

1. ________________________________________________________

_______

______

2. ________________________________________________________

_______

______

3. ________________________________________________________

_______

______

TO BETTER ASSIST YOU, WRITE A BRIEF STATEMENT OF WHAT YOU ARE REQUESTING

(Immunization records, enrollment dates, transcript, and for what purpose, etc.):

________________________________________________________________________________________________

Your Signature _________________________________________________ Date _____________________

This form will be filed with the Student Records Department to show you have requested this information. The school

does not release information concerning you to any non-educational organization, agency, or individual without your

consent.

OFFICE USE ONLY

RECORDS ISSUED BY (initials) _____ Records found by: Microfilm, Cum, Printout Book, Census Card, other _________________________

Inactive Student Records Release Of Information Form

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