Transcripts / Records Request

POMONA UNIFIED SCHOOL DISTRICT - MICRO-FILM DEPARTMENT

851 S. Hamilton Blvd., Pomona, CA 91766 - Ph: (909) 397-4800 x28200 - Fax: (909) 622-3027

Fill out this request form only if you were enrolled in PUSD from 2004 and prior

If you graduated or last attended from 2005 to present, contact the last school you attended.

For Adult School records, contact the Adult & Career Ed. office (909) 469-2333 or go to https://ace.pusd.org/

Last Name*

during time of enrollment

Answer required for "Last Name"

First Name*

during time of enrollment

Answer required for "First Name"

Phone Number*

include area code

Answer required for "Phone Number"

Date of Birth:*

Month/Day/Year

Answer required for "Date of Birth:"

High School name (PUSD):*

Answer required for "High School name (PUSD):"

Graduated*

Answer required for "Graduated"

Yes

Year graduated:

type N/A if you did not graduate

Answer required for "Year graduated:"

Non-Grad/Last Year Attended:*

type N/A if this does not apply to you

Answer required for "Non-Grad/Last Year Attended:"

Middle School name (PUSD)*

Answer required for "Middle School name (PUSD)"

Completed*

Answer required for "Completed"

Yes

n/a

Elementary school name (PUSD)*

Answer required for "Elementary school name (PUSD)"

Completed*

Answer required for "Completed"

Yes

n/a

Type of record(s) needed:*

Answer required for "Type of record(s) needed:"

High School

Middle School

Elementary School

Immunization Record

ALL

E-mail (if applicable)

Answer required for "E-mail (if applicable)"

Mailing Address (if applicable)

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Upload valid I.D. *

Answer required for "Upload valid I.D. "

Choose a file or drag it here.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Transcripts / Records Request

POMONA UNIFIED SCHOOL DISTRICT - MICRO-FILM DEPARTMENT