Fillable Records and Registration Student Data Request Form (Southern University at Shreveport)

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Records and Registration Student Data Request Form (Southern University at Shreveport)

On average this form takes 8 minutes to complete

The Records and Registration Student Data Request Form (Southern University at Shreveport) form is 1 page long and contains:

  • 1 signature
  • 13 check-boxes
  • 23 other fields

Country of origin: US
File type: PDF

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3050 Martin Luther King, Jr. Drive Phone: (318) 670-9229
Shreveport, Louisiana 71107 FAX: (318) 670-6344
www.susla.edu registraroffice@susla.edu
Submit the completed form (please print) and include documents, such as health insurance or loan deferment
forms, which need to be completed by the Registrar’s Office with this request. Requests are typically processed
within three to five business days once received and are processed on a first-come-first-served basis. During peak
times, such as registration or graduation, the process may be delayed.
Please be aware that enrollment verification requests for a current semester are processed after the official census
date (14
th
class day for Fall and Spring/7
th
class day for Summer).
Name
(Print):
Last
First
Middle
SUSLA Student ID#:
Contact Phone
Number:
SUSLA Skymail Address:
@skymail.susla.edu
Personal Email Address:
Enrollment Status:
Currently Enrolled Graduated Did Not Graduate
Anticipated Graduation Date/
Graduation Date:
Please indicate the type of data requested from the list below:
Standardized Test Scores (ACT/SAT)
Placement Scores (COMPASS or ACUPLACER)
Proof of Immunization
Residual ACT Scores
Other (specify):
*PLEASE ISSUE THE VERIFICATION LETTER TO:
Name (Organization): ______________________________________________________________________
Attention: ____________________________________ Email Address: ______________________________
Address __________________________________________________________________________________
Street Address City State Zip
Phone Number: ( )________________________ Fax Number: ( ) ________________________
To ensure that no person can obtain your information without your permission, if you have designated someone
(designee) to receive this information for you, please identify the person by name and ensure the designee is
able to provide picture official identification upon receipt.
Student’s Signature
Date
*Enrollment Verification
*Degree Verification
*Letter of Good Standing
*Letter of Non-Enrollment
*Good Student Discount
Records and Registration
Student Data Request Form
RO: Student Data Request Form: 07/14:Revised 07/16:07/17:08/19-LR
Registrar’s Office Use Only
Date Processed:
Processed by:
( )
Select One from the Dropdown Menue Below
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Records and Registration Student Data Request Form (Southern University at Shreveport)

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Completed 26 July 2020

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