1. Student Information

*
*
*
*
*
xxx-xx-
You must use this email in step 2 (payment) in order for payment to proccess.
*
*

2. Mailing Information

Destination

Edit
$$Destination1_Name1$$
$$Destination1_Name2$$
$$F4$$
$$Destination1_Address2$$
$$Destination1_City$$, $$Destination1_State$$ $$Destination1_ZipCode$$
$$Destination1_Country$$


Requested for this Address



Expedite Service = $22.00 per address (US Addresses Only, PO Box delivery not available with this option) Expedited services are currently unavailable

Attendance (1995 - present) = $2.00

State Standardized Testing (1995 - present) = $2.00

Immunization (1995 - present) = $2.00

School Information

Level School Name Did You Graduate Last Year Attended/Graduation Year
Charter Alumni / Closed Charter / Closed Private K-12 Did You Graduate Last Year Attended

School Selection - Technical

I acknowledge that selecting a technical school is a separate fee in addition to other schools selected.
Technical College Course Title Did You Graduate Last Year Attended/Graduation Year

Destination

Edit
$$Destination2_Name1$$
$$Destination2_Name2$$
$$Destination2_Address1$$
$$Destination2_Address2$$
$$Destination2_City$$, $$Destination2_State$$ $$Destination2_ZipCode$$
$$Destination2_Country$$


Requested for this Address



Expedite Service = $22.00 per address (US Addresses Only, PO Box delivery not available with this option) Expedited services are currently unavailable

Attendance (1995 - present) = $2.00

State Standardized Testing (1995 - present) = $2.00

Immunization (1995 - present) = $2.00

School Information

Official Copy = $3.00*
Certified Copy = $7.00*
School Level School Name Did You Graduate Last Year Attended/Graduation Year
Charter/Closed Private K-12 Did You Graduate Last Year Attended

School Selection - Technical

I acknowledge that selecting a technical school is a separate fee in addition to other schools selected.
Technical College Course Title Did You Graduate Last Year Attended/Graduation Year

Destination

Edit
$$Destination3_Name1$$
$$Destination3_Name2$$
$$Destination3_Address1$$
$$Destination3_Address2$$
$$Destination3_City$$, $$Destination3_State$$ $$Destination3_ZipCode$$
$$Destination3_Country$$


Requested for this Address



Expedite Service = $22.00 per address (US Addresses Only, PO Box delivery not available with this option) Expedited services are currently unavailable

Attendance (1995 - present) = $2.00

State Standardized Testing (1995 - present) = $2.00

Immunization (1995 - present) = $2.00

School Information

Official Copy = $3.00*
Certified Copy = $7.00*
School Level School Name Did You Graduate Last Year Attended/Graduation Year
Charter/Closed Private K-12 Did You Graduate Last Year Attended

School Selection - Technical

I acknowledge that selecting a technical school is a separate fee in addition to other schools selected.
Technical College Course Title Did You Graduate Last Year Attended/Graduation Year

Destination

Edit
$$Destination4_Name1$$
$$Destination4_Name2$$
$$Destination4_Address1$$
$$Destination4_Address2$$
$$Destination4_City$$, $$Destination4_State$$ $$Destination4_ZipCode$$
$$Destination4_Country$$


Requested for this Address



Expedite Service = $22.00 per address (US Addresses Only, PO Box delivery not available with this option) Expedited services are currently unavailable

Attendance (1995 - present) = $2.00

State Standardized Testing (1995 - present) = $2.00

Immunization (1995 - present) = $2.00

School Information

Official Copy = $3.00*
Certified Copy = $7.00*
School Level School Name Did You Graduate Last Year Attended/Graduation Year
Charter/Closed Private K-12 Did You Graduate Last Year Attended

School Selection - Technical

I acknowledge that selecting a technical school is a separate fee in addition to other schools selected.
Technical College Course Title Did You Graduate Last Year Attended/Graduation Year

Destination

Edit
$$Destination5_Name1$$
$$Destination5_Name2$$
$$Destination5_Address1$$
$$Destination5_Address2$$
$$Destination5_City$$, $$Destination5_State$$ $$Destination5_ZipCode$$
$$Destination5_Country$$


Requested for this Address



Expedite Service = $22.00 per address (US Addresses Only, PO Box delivery not available with this option) Expedited services are currently unavailable

Attendance (1995 - present) = $2.00

State Standardized Testing (1995 - present) = $2.00

Immunization (1995 - present) = $2.00

School Information

Official Copy = $3.00*
Certified Copy = $7.00*
School Level School Name Did You Graduate Last Year Attended/Graduation Year
Charter/Closed Private K-12 Did You Graduate Last Year Attended

School Selection - Technical

I acknowledge that selecting a technical school is a separate fee in addition to other schools selected.
Technical College Course Title Did You Graduate Last Year Attended/Graduation Year

3. Authorization Notification

I authorized Broward Public Schools to release the indicated information and / or my education record. I confirm I completed all sections accurately and truthfully, including information verifying my identity.


I certify, under penalty of perjury, pursuant to Florida Statute Section 92.525, that I am the former/student requesting my records, or the parent/guardian of a former student (who is under the age of 18 or meets other statutory requirements ) requesting records of said student. I declare under penalty of perjury that the foregoing is true and correct.

*Request will be refused and refunded if there is not a full signature



Supporting Documentation

Please attach a copy of your state issue ID below.

If applicable please attach supporting documents below
ex : Legal name change docs, 3rd Party signed documents, etc...


4. Order Review

ID Name Number of Copies Price
B9858-1 Transcript Request - Official Copy 0 $0.00
B9858-2 Transcript Request - Certified Copy 0 $0.00
B9858-5 Immunization Record 0 $0.00
B9858-4 State Standardized Testing 0 $0.00
B9858-3 Attendance Report 0 $0.00
B9858-6 Expedite Service 0 $0.00
Total: $0.00

Please ensure your order is correct before continuing. The next screen will redirect you to the payment page and you will not be able to come back to make changes to this form. CHECK YOUR INBOX FOR ORDER REVIEW AND VERIFICATION.