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The Florida 4191A form serves as an essential tool for individuals seeking to obtain their academic transcripts from the School Board of Broward County. Designed specifically for students who attended school seven years ago or earlier, this form streamlines the process of requesting official or certified transcripts. For those who attended school within the last seven years, a different procedure applies, directing them to contact their last school directly. When completing the form, applicants must provide personal details, including their name, date of birth, and social security number, alongside a valid form of identification. The form outlines a clear fee structure, charging $3.00 for each official transcript and $7.00 for certified copies, with payment accepted only in cash or money order. It is important to note that personal checks are not accepted, and any incomplete submissions will be promptly returned. Additionally, this form is not intended for GED requests, making it crucial for applicants to ensure they meet the criteria before proceeding. By following the instructions carefully and ensuring all required information is provided, individuals can successfully navigate the process of obtaining their educational records.
Form Example
The School Board of Broward County
Records Retention
Transcript Request
7720 W. Oakland Park Blvd., 3rd Floor
Sunrise, FL 33351
Instructions: This form is for students requesting transcripts from 7 years ago and prior. If you attended within the last 7 years, contact your last school. Mail this form and copy of identification to Records Retention, to address shown above. Transcript fee for each copy is $3.00 for official (College, Employment, SS, etc.) OR $7.00 for certified (Immigration, Subpoenas, etc.), cash or money order only made to: The School Board of Broward County. No personal checks accepted. All request received incomplete or
unacceptable will be returned immediately. |
Check one: |
|
OFFICIAL ___ CERTIFIED___ |
*This form is not for GED request.
*Student Name _______________________________________ *DOB ____________________
Married/Other Name ___________________________________ SSN ____________________
*Home Phone ______________________ Work _______________ Cell ____________________
*Last public BROWARD County
*Last year in school __________ Did you graduate? Yes OR No If no, last grade attended______
Program Title (if applicable)__________________Attendance Dates _________________________
Did you complete the tech program? Yes or No, $3 Elem___$3 Middle___$3 High___$3 Tech__
Mail to:
Name ________________________________________________________________________
Address_______________________________________________________________________
______________________________________________________________________________
City _________________________________State___________ Zip _______________________
Mail to:
Name ________________________________________________________________________
Address_______________________________________________________________________
______________________________________________________________________________
City _________________________________State___________ Zip _______________________
Authorization Statement and Authorized Signature
I certify, under penalty of perjury, pursuant to Florida Statute Section 92.525, that I am the former student requesting my records. I hereby authorize the release of records or information as instructed above.
*Student INK Signature __________________________________________________________
Date__________________ |
ATTACH PHOTO ID BEFORE MAILING |
*REQUIRED |
Form 4191A
REV 08/19
Records Retention
Document Breakdown
| Fact Name | Details |
|---|---|
| Purpose | This form is designed for students to request transcripts from the School Board of Broward County for records that are 7 years old or older. |
| Governing Law | The form is governed by Florida Statute Section 92.525, which pertains to the release of educational records. |
| Submission Method | Students must mail the completed form along with a copy of their identification to the Records Retention office at the specified address. |
| Transcript Fees | The fee for an official transcript is $3.00, while a certified transcript costs $7.00. Payment must be made via cash or money order. |
| Payment Restrictions | Personal checks are not accepted for transcript fees; only cash or money orders made out to the School Board of Broward County are permitted. |
| Incomplete Requests | Any request that is incomplete or deemed unacceptable will be returned immediately to the sender. |
| Eligibility | This form is not applicable for GED requests; it is strictly for high school and vocational transcripts. |
| Signature Requirement | Students must provide an ink signature on the form, certifying their request under penalty of perjury. |
| Identification | Students are required to attach a photo ID before mailing the request to ensure proper identification. |
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