Student Records Request Form

Syracuse City School District
Student Records Department
220 W. Kennedy St
Syracuse, NY 13205
Ph: 315-435-4103
Fax: 315-435-4939
e-mail: records@scsd.us

Student First Name: *

Student Last Name: *

Student Date of Birth: *

Current Name (if different):

Current Street Address:

City:

State:

Zip Code:

Current Daytime Phone Number: *

Alternate Number:

E-Mail Address:

Please enter an E-Mail address where the Records Department can reach you with any questions.

Year of Graduation/Left:

School Last Attended: *

Dates Attended:

Record Requested: *

Transcript

Immunization

Duplicate Diploma $5.00 w/out cover

Duplicate Diploma $8.00 with cover

Other

Please select the type of record that you are requesting

Transcript (no charge)
Immunization (no charge)

Please allow 3-5 Business Days for delivery of mailed transcripts and immunization requests.

Duplicate Diploma $5.00 w/out cover
Duplicate Diploma $8.00 with cover

Mail request with a money order made payable to: Syracuse City School District, Or You may also submit this request in person at our office with cash or money order. Please note that all diploma requests are pre-paid only. Please allow 3-4 weeks for delivery of duplicate diplomas.

Record Purpose: *

Schools

Work

Other

Delivery Method: *

Fax

Mail

Pick Up

Please select a delivery method. If you select email, fax, or mail please enter the destination address/number in the Notes/Comments/Additional Information field below.

Notes/Comments/Additional Information:

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Sharon L. Contreras, Superintendent

Central Offices, 725 Harrison Street, Syracuse, NY 13210 Mailing Address 1025 Erie Boulevard West Syracuse, NY 13204 (315) 435-4499

Acceptable Use Policy