This is an official request for an aspect of the student record. The information contained in this request should be considered private. Please complete all information in full and then finalize the order process via electronically initialing this document.

The District will help our current students and graduates apply for this opportunity as best we can by providing available enrollment histories and school transcripts:

  • For individuals who were under the age of 31 as of June 15, 2012
  • For individuals who came to the United States before reaching their 16th birthday
  • For individuals who have continuously resided in the United States since June 15, 2007
  • For individuals who entered without inspection before June 15, 2012, or your lawful immigration status expired as of June 15, 2012
  • For individuals who are currently in school, have graduated or obtained a certificate of completion from high school, have obtained a general education development (ED) certificate, or are an honorably discharged veteran of the Coast Guard or Armed Forces of the United States
Name While Attending School:

Gender Information:

Information Related To Your Birth:

Your Last LAUSD School of Attendance:

Current Name:

Current Residence Address: (this may be different than the mailing address)

Current Mailing Address: (if different from residence address)

Telephone Number: (###-###-####)


Documents Will Be Delivered To: please enter the delivery addresses
Name Attention Addr 1 Addr 2 City State Zip Country # of Copies

Reason(s) for Request of Student Record:

Select The Information Type(s) Requested:

Total Fee:
My initials below constitute an electronic signature and authorizes the Records Department of The Los Angeles Unified School District to release information and / or my student record and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.
I understand that an incomplete form (i.e. a form whereby required additional documentation is not received) will not be processed and will be considered closed after expiration of the 30 day notification window. I declare under penalty of perjury that the foregoing is true and correct.
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