Last Name used while attending*

First Name*

Middle Name

Married/Other Name

Date of Birth (mm/dd/yyyy) *

Email Address*

Phone Number *

Social Security Last 4 Numbers

xxx-xx-

Confirm Email Address You must use this email in step 2 (payment) in order for payment to proccess.

Current Address*

City*

State

Zip Code

Country

Mail to this address

International address

Mailing Address 1

Mail To:

Edit

$$Destination1_Name1$$

$$Destination1_Name2$$

$$F4$$

$$Destination1_Address2$$

$$Destination1_City$$, $$Destination1_State$$ $$Destination1_ZipCode$$

$$Destination1_Country$$

International Address

Mail To: (Name / School / Compnay)

Street Address

City

State

Zip Code

Country

Qty

~~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

Official Copy = $3.00*

Certified Copy = $7.00*

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

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

Offical Copy = $3.00	Certified Copy = $7.00

Mailing Address 2 +

Mail To:

Edit

$$Destination2_Name1$$

$$Destination2_Name2$$

$$Destination2_Address1$$

$$Destination2_Address2$$

$$Destination2_City$$, $$Destination2_State$$ $$Destination2_ZipCode$$

$$Destination2_Country$$

International Address

Mail To:

Street Address

City

State

Zip Code

Country

Qty

~~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

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

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

Offical Copy = $3.00	Certified Copy = $7.00

Mailing Address 3 +

Mail To:

Edit

$$Destination3_Name1$$

$$Destination3_Name2$$

$$Destination3_Address1$$

$$Destination3_Address2$$

$$Destination3_City$$, $$Destination3_State$$ $$Destination3_ZipCode$$

$$Destination3_Country$$

International Address

Mail To:

Street Address

City

State

Zip Code

Country

Qty

~~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

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

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

Offical Copy = $3.00	Certified Copy = $7.00

Mailing Address 4 +

Mail To:

Edit

$$Destination4_Name1$$

$$Destination4_Name2$$

$$Destination4_Address1$$

$$Destination4_Address2$$

$$Destination4_City$$, $$Destination4_State$$ $$Destination4_ZipCode$$

$$Destination4_Country$$

International Address

Mail To:

Street Address

City

State

Zip Code

Country

Qty

~~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

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

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

Offical Copy = $3.00	Certified Copy = $7.00

Mailing Address 5 +

Mail To:

Edit

$$Destination5_Name1$$

$$Destination5_Name2$$

$$Destination5_Address1$$

$$Destination5_Address2$$

$$Destination5_City$$, $$Destination5_State$$ $$Destination5_ZipCode$$

$$Destination5_Country$$

International Address

Mail To:

Street Address

City

State

Zip Code

Country

Qty

~~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

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

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

Offical Copy = $3.00	Certified Copy = $7.00

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.

By typing my name below I acknowledge I agree to the above statement.

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

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...

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

1. Student Information

2. Mailing Information

Mailing Address 1

Destination

Requested for this Address

School Information

School Selection - Technical

Mailing Address 2 +

Destination

Requested for this Address

School Information

School Selection - Technical

Mailing Address 3 +

Destination

Requested for this Address

School Information

School Selection - Technical

Mailing Address 4 +

Destination

Requested for this Address

School Information

School Selection - Technical

Mailing Address 5 +

Destination

Requested for this Address

School Information

School Selection - Technical

3. Authorization Notification

Supporting Documentation

4. Order Review