The information collected on this form is subject to the Municipal Freedom of Information and Protection of Privacy Act. Questions about the collection of this personal information should be directed to the
Controller, Simcoe County District School Board, 1170 Highway 26, Midhurst, ON L9X 1N6 (705) 734-6363 ext. 11254.
FORM A1456 - 1; Rev. 06/2021
REQUEST FOR TRANSCRIPTS AND DUPLICATE DIPLOMAS
Date of Birth (year/month/day)
DOCUMENT INFORMATION
Ontario Student Transcript
# of originals requested: ____
Duplicate Diploma
Mail to the current mailing address above
Mail to this address: _________________________________________
____________________________________________________________
Email to the Email address above (a paper copy will not be mailed to you)
CHECKLIST OF FORMS AND SUPPORTING DOCUMENTATION (to be completed and submitted by student)
Completed and Signed Request Form
Completed Signed Authorization Form required for release to a third party (Link to Website)
Photo Identification of requester
Photo identification of third party (required when a third party is authorized to pick up a transcript)
During the school year and the first week in July and the last week in August, requests are processed by the school. Refer to the
Board website for school names and addresses. (School Directory). During the second week in July to the third week in August,
requests are processed at our Education Centre 1170 Highway 26, Midhurst, Ontario. Contact (705) 728-7570 with questions.
AU
THORIZATION
Applicant’s Signature: ____________________________________________ Date: ________________________________
FO
R OFFICE USE ONLY
(to be completed by board staff)
Photo identification
Other data elements, i.e. courses taken, place of birth, etc. to be
used when original photo identification is not possible. Refer to APM
Date:
Signature:
Last Secondary School Attended
OEN – Ontario Education Number (if known)
Last Name used during school
Current Mailing Address (street, city, postal code)
Mailing address when last attended (if different than current)
Cell Phone
click to sign
signature
click to edit
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