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Request For Ontario Student Academic RecordsRequest For Ontario Student Academic Records Note: For use ONLY by students who attend or last attended an Ottawa-Carleton District School (or a former Ottawa or Carleton Public School) Reference: Procedure PR.646.SCO Please complete the fields below, and select the last school attended. The record you are requesting will be provided electronically to the organization or institution requiring it. You will be copied on the email. This form is also available electronically here. Be advised that you must provide a copy of your government-issued photo identification (i.e. driver's license, health card, passport, etc.) to authenticate your identity. Upon issuance of the requested record, the identification document will be expunged. A. APPLICANT INFORMATION (To be completed by applicant) Last Name: First Name: Last Name or Family Name while in School: Other Names Used: Date of Birth (YYYY/MM/DD): Home Telephone: Business/Cell Telephone: Current Home Address: Postal Code: City/Country: If your school is still open select it from the dropdown: If your school is closed select it from the dropdown: Last Grade Completed: Year of Graduation/Retirement: To update your gender identity on your record, please indicate your gender identity. No documentation required. B. DOCUMENTS REQUESTED (To be completed by applicant) To request a change to your preferred FIRST name, please indicate your preferred FIRST name. No documentation required. To request a change to your preferred LAST name, please indicate your preferred LAST name. No documentation required. For more information regarding the Continuing Education programs, please click here. What year was the program attended?: Additional Details: IfIf your last program was taken through Continuing Education please select it from the dropdown: Additional Details: Would you like these changes to be reflected in the selected document requests below?: Yes No Eligibility for English Instruction in Quebec ($25) Duplicate Diploma ($24) Other: Please Specify What Information is Being Requested: Education Verification ($25) Letter of Attestation ($25) Subject Matter of Letter: C. DISTRIBUTION OF RECORD Applicant will be copied to Applicant's email address as provided above. Name of Organization/Institution to Which the Record is Sent: Ontario Student Transcript ($24) Legal Requests for information ($25) Please Specify What Information is Being Requested: What kind of record is being requested?: Please provide additional details with regard to your request.: The personal information on this form is collected under the authority of the Education Act (R.S.O. 1990 c.E2), and in accordance with the Municipal Freedom of Information and Protection of Privacy Act (RSO. 1990 c.M56), as amended. It will be used to issue requested Ontario Student Records. In addition, the information may be used or disclosed to comply with legislation, for compelling circumstances affecting health and safety, and as required in circumstances related to law enforcement matters. Questions or concerns should be directed to the school principal or the District’s Freedom of Information Coordinator, Ottawa-Carleton District School Board, 133 Greenbank Road, Ottawa, Ontario K2H 6L3, Telephone 613- 596-8211. CONFIDENTIAL WHEN COMPLETED. E. METHOD OF DELIVERY (To be completed by applicant) How would you prefer to receive your documents?: Send via email Mail to home address In-person pickup In person pickup will be done by: Myself Someone else on my behalf (A show of ID will be required at pick up) Name of indivudual picking up: Date: By checking this box, I authorize access to my Ontario Student Record, and I hereby certify that the information entered on this form is true and correct. Date: D. IDENTIFICATION AND AUTHORIZATION (To be completed by applicant) Please Provide a Copy of a Government-Issued Photo Identification and/or Other Pertinent Information. (Ex. Driver's License, Passport, Health Card and/or Letter from Organization Requesting Information.) Address or Email of Organization/Institution to Which the Record is Sent: Signature: