Indicate who/where you want the records sent by checking appropriate box(es) OR providing name(s), address(es)
and/or fax number(s) in the boxes below:
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
DIVISION OF INFORMATION TECHNOLOGY / RECORDS MANAGEMENT
Student Transcript / Records Request
This form is used to request transcripts/records for students who last attended Palm Beach County public school programs
three (3) or more years ago or request transcripts/records from schools that are closed. All other requests should be sent
directly to the current/last school the student attends/attended.
Student Birth Date
Social Security # (last 4 digits)
Name(s) used while attending school (first, middle, last)
Current name (if different than above - first, middle, last)
Current Telephone #
Last Year in School
Yes
No
Did you graduate?
Indicate which records you are requesting (check all that apply):
High/Middle School Transcript Elementary School Records
Unofficial GED Transcript
Year GED Received
Immunization Records
Indicate the number
of copies you are
requesting:
Employment Education Personal Use
Other
Central Jupiter Port St. Lucie
Indian River State College
Southeastern College (Formerly Keiser)
South College/University
Fortis Institute
Palm Beach State College (PBSC)
Florida Atlantic University (FAU) (check campus below)
Mail Fax transcript to:
Name
Address City
State Zip Code Fax Number
Mail Fax transcript to:
Name
Address City
State Zip Code Fax Number
PBSD 1457 (Rev. 2/11/2016)
SIGNATURE OF FORMER STUDENT/PARENT/GUARDIAN REQUIRED
DATE
Student ID # (if known)
Purpose of Request:
If No, indicate last grade attended
Current address
I certify, under penalties 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.
Complete the information requested below. A signature is required. The requested records will be mailed or faxed within 7
business days after receipt of a completed request. The requests for records of individuals who attended prior to 1992 may
not be computerized and may take additional time to complete. MAIL to The School District of Palm Beach County Records
Management, 3344 Forest Hill Blvd., Suite B-201, West Palm Beach, FL 33406 OR FAX (561) 434-8660.
Immigration
Name of Last Public School Attended in the Palm Beach County School District (including k-12, adult, vocational, etc.)
