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OCDSB 539 Transfer & Rqust for OSR Nov STUDENT TRANSFER FORM / REQUEST FOR ONTARIO STUDENT RECORD (OSR) (EXTERNAL TO THE OCDSB) (R:PPR.539.SCO) EFERENCE ROCEDURE PART A: DEPARTING SCHOOL This is to certify that: Student's Name Date of Birth OCDSB Home Room No. Student ID No. Student’s Address Was in attendance at: School's Name School's Address From To His/Her Present Placement Is General Comments Transferred to: School's Name School's Address ______________________________________ ________________________________________________ Date School Official Your health unit may obtain health records from: OTTAWA PUBLIC HEALTH 100 Constellation Crescent Ottawa, Ontario K2G 6J0 The Ontario School Record Folder for this student will be forwarded directly to you upon receipt of this form (completion of Part B) or alternatively, a request in the form of a letter on official letterhead. The parent/guardian, or student, has been provided with a copy of his/her latest report card and Ontario Student Transcript, if applicable. -------------------------------------------------------------------------------------------------------------------------------------------- PART B: RECEIVING SCHOOL CONFIRMATION OF REGISTRATION/OSR OFFICIAL REQUEST This is to confirm that: Student's Name Student's Address Student's ID No. Has registered at: School's Name School's Address ______________________________________ ________________________________________________ Date Parent/Guardian/Student Signature I hereby agree to accept responsibility for the record and to use, maintain, transfer, and dispose of the record in accordance with the Ministry of Education’s Ontario Student Record (OSR): Guideline, 2000 and the Education Act. ______________________________________ ________________________________________________ Date School Official Personal information on this form is collected under the authority of the Education Act and will be used for the purposes of a request for the transfer of an OSR outside of the OCDSB. If you wish to review this information or have questions regarding its collection, please contact the principal of the school where the student is registered. OCDSB 539 School Operations (November 2009) Page 1 of 1