RECORDS REQUEST
LAKE WASHINGTON INSTITUTE OF TECHNOLOGY, 11605 132
ND
AVENUE NE, KIRKLAND, WASHINGTON 98034-8506
LWT
ECH.EDU | REGISTRATION@LWTECH.EDU |PHONE: (425)739-8104 | FAX: (425) 739-8110
Please complete and return the following information to
Enrollment Services in West Building, W201
ALLOW 2 WEEKS FOR PROCESSING
RECORDS REQUESTED BY:
(please print)
Name:
Address:
City: Sta
te: Zip:
RECORDS REQUESTED:
Official Transcript Number Needed
Unofficial Transcript
After grades/degree posted
Other: Please explain
Student Authorization:
I hereby authorize Lake Washington Institute of
Technology to send the confidential records
requested above to the recipient identified
herein.
Student Signature:
Date:
Student Information:
Social Security Number: - -
LWTech Student ID: - -
Birthdate: -
-
Phone: ( )
-
Course or Program:
Previous Name (if different when registered)
Last year and Quarter:
Fall
Winter Spring Summ
er
Records to Be Sent to:
Check here if same address as above
Please print clearly
To:
Street:
City: State: Zip:
Additional Addresses (Please print clearly):
1. To:
Street:
City: State: Zip:
2. To:
Street:
City: State: Zip:
Want to pick up my transcript
Aft
er Grades posted
Check if you want to include current quarter grades
Enrollment Services Use Only
Date Received by
Date Ordered by
Date Sent by
Records Sent:
Official Transcript #Sent
Unofficial Transcript
Other:
Comments:
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signature
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