DOCUMENT REQUEST FORM

DOCUMENT REQUEST FORM

IDENTIFICATION OF THE PERSON CONCERNED (former student)

* LAST NAME

* GIVEN NAME

* DATE OF BIRTH (YYYY-MM-DD)

PERMANENT CODE (if known)

* MOTHER'S FAMILY NAME AT BIRTH

* MOTHER'S GIVEN NAME

* FATHER'S LAST NAME

* FATHER'S GIVEN NAME

* EMAIL

* TELEPHONE (daytime)

* SCHOOLS ATTENDED WITHIN THE SIR WILFRID LAURIER SCHOOL BOARD BEGINNING WITH LAST SCHOOL (include elementary and secondary schools, adult education & vocational training centres)	YEAR	GRADE

IDENTIFICATION OF THE PARENT/GUARDIAN MAKING REQUEST (for minor child)

LAST NAME

GIVEN NAME

DATE OF BIRTH (YYYY-MM-DD)

TELEPHONE (daytime)

* DOCUMENT(S) REQUIRED

Report Card(s)

School

Grade

Letter of attestation of
school attendance

Other | please specify

For Achievement Records and/or Diplomas, please click here

* REASON FOR REQUEST

Post-secondary education

Employment

Other | please specify

* DELIVERY OPTIONS

PICK UP AT THE HEAD OFFICE

SIR WILFRID LAURIER SCHOOL BOARD
235, Montée Lesage, Rosemère (Québec) J7A 4Y6
450 621-5600 | archives@swlauriersb.qc.ca

If the person making the request wishes to designate someone to pick up the document(s) on their behalf, they must print and complete an authorization form.

EMAIL TO:

MAIL TO THE FOLLOWING ADDRESS
(Please expect longer delivery time.)

NAME

ADDRESS (number, street, apt., or P.O. box)

CITY

PROVINCE

POSTAL CODE

TELEPHONE (daytime)

* I certify that the information in this document is true and correct.
By clicking “SUBMIT REQUEST”, I understand that this acts as my signature.

UPLOAD PHOTO ID* HERE
*ex: driver’s licence, Health Insurance Card, passport. (JPEG or PDF - 1 MB or less)

* DATE