Students Records Request Form printable pdf download

Students Records Request Form

SYRACUSE CITY SCHOOL DISTRICT

Student Records

Jaime Alicea

1005 West Fayette Street• Syracuse, NY 13204

Interim Superintendent of Schools

Phone 315•435•4103• Fax 315•435•4939

Records@scsd.us

Department Use Only

Student Records Request Form

Student ID: ______________

Verified ID

Student Name:

Date of Birth:

Current Name (if different):

Current Address:

City, State, Zip:

Contact Phone Number(s):

Last SCSD School Attended:

Year of Graduation/Last Year Attended:

Please select from the following:

Purpose of the Records:

Transcript

School

Immunizations

Work

Other: ______________________________

Other

Duplicate Diploma

$5.00 without cover

$8.00 with cover

(Cash or Money Order made payable

to Syracuse City School District)

Please choose a delivery method:

Pick Up

Email: _____________________________________________________

Fax: _______________________________________________________

Other: _____________________________________________________

Signature: ______________________________________________

Date: _______________________

Students Records Request Form