UPPER GRAND DISTRICT SCHOOL BOARD
500 VICTORIA ROAD NORTH, GUELPH, ONTARIO, N1E 6K2
PHONE: (519) 822-4420 FAX: (519) 826-9534
Martha Rogers, Director of Education
REQUEST FOR ONTARIO STUDENT TRANSCRIPT AND OTHER STUDENT RECORDS
TYPE OF RECORD REQUESTED:
Ontario Student Transcript
Proof of Age
Proof of Attendance
Verification of Education
Other: Please specify:
PROCEDURE:
1.
2.
3.
Complete this form and deliver it (in person or by mail) to the last school you attended, together with two pieces of identification e.g. Birth
Certificate, Driver’s License, Passport. (Photocopies are acceptable.)
Enclose a cheque or money order for the total amount due, payable to the school. Payment MUST be received before the request is
processed.
Should you wish to have someone pick up your Record(s), you must provide a letter of permission naming the person and sign the letter. The
person authorized to pick up the record will be asked to produce identification.
PERSONAL INFORMATION: (Please print or enter electronically)
Surname
First Name
Number
Initial
Street
Maiden Name
City
Name of School Last attended in Upper Grand District School Board
(formerly Wellington or Dufferin Counties)
Final Year
Province
Postal Code
Telephone Number
D.O.B.
(yyyy/mm/dd)
COST:
NOTE: Present students are not charged for Transcripts or other records. Charges apply to students retired for one year or more. Past students or employers will be charged at
the rate below, inclusive of regular postage. Any costs incurred for premium shipping (courier, express post, etc.) will be the responsibility of the applicant.
Total number of copies required:
X $5.00 for each copy
DELIVERY INSTRUCTIONS:
Address above
Pick Up
=
Total Amount Due
Send record(s) to:
Prospective Employer:
Name
OUAC number
Name of University
OUAC number
Name of University
OUAC number
Name of University
OCAS number
Name of College
Other:
Particulars:
Signature of Applicant or Designate:
Date:
(yyyy/mm/dd)
FOR SCHOOL USE ONLY
9
Identification Received
Signature of School Staff:
9 Transcript Picked Up
9 Transcript Mailed
Date:
(y/m/d)
The authorization for the collection of this information is in the Education Act and Ontario Student Record Guidelines. The purpose is to receive proof of identification for
the release of school records. The school’s Administrative Staff will be the primary users of this information. Contact person for queries is the School Principal.
Revised 2010/03
Ad-*opted 1994/04