Student Record Request Form
Office of Shared Accountability
Central Records Office
7210 Hidden Creek Road, Bethesda, Maryland 20817
MCPS Form 226-8
January 2021
If you graduated or withdrew four or fewer years ago contact your former school to obtain your transcript and/or school records
If you graduated or withdrew five or more years ago, you are requesting a: o Transcript o Diploma
1. Complete PART A only, print out form and sign where indicated.
2. Fees: $5.00 per transcript and $15.00 per diploma. Please visit the Online School Payment system to make your payment
electronically. Other acceptable payment forms: cash, check or money order payable to “MCPS.”
3. Transcript Requests: Send a self-addressed, stamped business-sized envelope(s), one envelope per each transcript requested.
Diploma Requests: Include mailing address for diploma (no envelope necessary) (Please allow up to 8 weeks for replacement
diploma processing).
4. Mail above items to Central Records (address above).
Questions? Call Central Records: 240-740-5270
WALK-IN REQUESTORS: Complete and sign PART A only.
Part A: Requestor Information
Name When Enrolled in MCPS: Last_____________________________________ First __________________________________ MI _____
Current Name (if different): Last_____________________________________ First ____________________________________ MI
Name As It Should Appear on Diploma: _________________________________________________________________________________
School graduated or withdrawn from ____________________________________________________________________________________
Date of Birth____/____/______ Month/Year of graduation
Year of withdrawal
I verify that I am entitled to receive the records requested above because: MUST check one of the boxes below:
o I am the subject of such records
o I am authorized by the subject of the record to receive their school records (documentation attached)
Requestor’s Signature __________________________________________________________________________ Date ____/____/______
Current Address ______________________________________________________________________________________________________
City ________________________________________________________________________________State_____ ZIP Code_______________
Phone no._____-_____-______
Part B: FOR OFFICE USE ONLY—Requestor Information other than above (e.g., phone verifications, etc.)
Last MI
Phone no. _____-_____-______
Type of record request (CHECK ALL THAT APPLY): o transcript o verification letter o diploma o all school records
o IMM o SAT o PSY o IEP o subpoena o phone verification o attendance
No. of copies
Amount paid $ o No charge
Paid with: o Online School Payment Confirmation Number ______________________________________________________________
o cash o check #
o money order _____________________________________________________________
Mode of request: o walk in o mail o fax o phone o pony o e-mail
Reel # Image # o Scanned o Hard copy
Date received ____/____/______ date completed/sent ____/____/______ by _______________ (initials)