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OCDSB 646 Requests For Ontario Student Academic RecordsOCDSB 646 Corporate Records (September 2017) Page 1 REQUEST FOR ONTARIO STUDENT ACADEMIC RECORDS (Reference: Procedure PR.646.SCO) Note: For use ONLY by students who attend or last attended an Ottawa-Carleton District School (or former Ottawa or Carleton Public School) Please submit this completed form to the last secondary school attended or, if permanently closed, to Corporate Records, 133 Greenbank Road, Ottawa, ON K2H 6L3. Government-issued photo identification (Driver’s License/Health Card/Passport) is required. If the request is made by mail, fax or email, a copy of the applicant’s photo identification must be sent with this form to the last school attended. See the school’s website: School Contact Information. If the school is permanently closed, send to Corporate Records: corporate.records@ocdsb.ca. If the applicant designates another individual to pick up the requested documents (see Section D), the individual must present photo identification at the time of pick-up. See Section E for forms of payment accepted. A. APPLICANT INFORMATION (To be completed by applicant) Date of Request: Last Grade Completed: Year Completed: Last School Attended: Last Name or Family Name while in school: First Name: Other Names Used: Date of Birth (M/D/Y): Telephone No.: Email: B. DOCUMENTS REQUESTED (To be completed by applicant) ONTARIO STUDENT TRANSCRIPT (OST) Within one year of leaving the school, two OSTs are issued free of charge. Subsequent copies are $5.00 each. No. Requested Fee: Students who have been away from their school for more than one year will be charged $24.00 for the first copy and $5.00 for each additional copy. DUPLICATE DIPLOMA Fee: $24.00 LEGAL REQUESTS FOR INFORMATION ($25.00) EDUCATION VERIFICATION ($25.00) LETTER OF ATTESTATION ($25.00) Fee: $25.00 Specify subject matter of letter: ELIGIBILITY FOR ENGLISH INSTRUCTION IN QUEBEC ($25.00) (All forms to be completed by Corporate Records-133 Greenbank Rd., Ottawa) Fee: $25.00 PHOTOCOPIES / MICROFICHE COPIES (20 CENTS/PAGE) No. of Pages: Fee: CERTIFICATE OF FRENCH IMMERSION Fee: $25.00 OCDSB 646 Corporate Records (September 2017) 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 the principal, or Corporate Records, as applicable. D. DISTRIBUTION INFORMATION (To be completed by applicant and office personnel) PICKUP by Applicant to the MAIL to home address and/or following: OR PICKUP by Other (Complete below) I authorize release of the above requested documents to (print full name and relationship) Fax Scan and email to: 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 E. FORM OF PAYMENT Make cheques and money orders payable to the school, or to the Ottawa-Carleton District School Board (for closed schools only). Some schools can process online payments – For contact information, refer to the school website. Do not provide credit card information via email or fax. Contact the school directly, or Corporate Records (613-596-8211 ext. 8591), as the case may be. To be completed by office personnel: Cash Certified Cheque Money Order Debit Credit Card (VISA or MC) Fee Rendered: $ _________________ _______________________ _ (Signature of office personnel) (Position) (Date) 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. Or Check Box if submitting electronically