Request For Student Academic Records (Page 2 of 2) in pdf

Request For Student Academic Records Page 2

C. AUTHORIZATION (To be completed by applicant)

Signature of applicant:

______________________________________________

(Authorizing access to Ontario School Record)

The personal information provided is collected under the authority of sections 58.5(1) and 265(d) of the Education Act, R.S.O. 1990, c.E2, as

amended. The information will be used as necessary for the retrieval of your academic record and the processing of your request. Questions

regarding this collection should be directed to Corporate Records.

D. DISTRIBUTION INFORMATION (To be completed by applicant and office personnel)

PICKUP by Applicant

MAIL to home address and/or

to the following:

OR PICKUP by Other (Complete below)

I authorize release of the above requested documents to

(print full name and relationship)

Fax No. (If document to be faxed):

Additional Information:

(Signature of individual picking up document)

Government photo ID is presented at pick up by applicant or designated individual

(or copy provided by applicant if requested by email/fax)

Date of Pickup/Mail: _____________________________________

To be completed by office personnel

Documents not picked up will be maintained for two months from the date of the request,

following which they will be shredded.

No refunds are given.

E. FORM OF PAYMENT (To be completed by office personnel)

Certified cheques/money orders are payable to the Ottawa-Carleton District School Board.

Debit & Credit available at 133 Greenbank only (Records for Closed Schools)

 Cash

 Certified Cheque

 Money Order

 Debit

 Credit Card (VISA or MC)

Fee Rendered: $ _________________

_______________________________ ________________________________

____________________________

(Signature of office personnel)

(Position)

(Date)

OCDSB 646 Corporate Records (November 2015)

Request For Student Academic Records Page 2