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Transcripts / Records Request

POMONA UNIFIED SCHOOL DISTRICT

Transcripts/Records Request Form

Please note: This form is only for RECORDS PRIOR TO 2005. All others must request records through school last attended--GO HERE and click "select a school" at the top.

If you have any questions, please contact our office:

Pupil Resources Department

851 S. Hamilton Blvd., Pomona CA, 91766

(909)397-4800 x28200

M-F 8:00 AM-4:30 PM

First Name*

During time of enrollment

Answer Required

Last Name*

During time of enrollment

Answer Required

Phone Number*

Answer Required

Date of Birth:*

Answer Required

Year graduated:*

If you did not graduate, please indicate N/A and move on to the next question.

Answer Required

If you did not graduate, please indicate the year last attended & grade level:

Answer Required

School last attended:*

Answer Required

Quantity needed:*

Answer Required

Type of record needed:*

Please note: Prior to 2013, schools were not required to archive immunization records.

Answer Required

High School

Middle School

Elementary School

Immunization Record

ALL

Did you complete MIDDLE SCHOOL?*

Answer Required

Yes

What is the name of the MIDDLE SCHOOL you attended?*

Answer Required

Did you complete ELEMENTARY SCHOOL?*

Answer Required

Yes

What is the name of the ELEMENTARY SCHOOL you attended?*

Answer Required

If you have a specific request, please indicate below:

Answer Required

Please provide details of the delivery method here (e-mail, fax or address):*

If picking up, please indicate N/A

Answer Required

Please upload a valid I.D.*

Answer Required

Choose a file or drag it here.

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required