10/2016
For Office Use Only:
Date Received: Date Verified:
LSU Carrol L Herring Fire and Emergency Training Institute
Certification Program
REQUEST FOR OFFICIAL CERTIFICATION TRANSCRIPT
Individual Information:
Print Full Name:__________________________________________ Date of Birth:___________________
Last 4 digits of SSN:__________________________ Contact Number: _____________________________
Mailing Address:___________________________________ City/State/Zip:_________________________
Email: _________________________________________ Fire Department ID: _____________________
Certification records are education records of individuals and are therefore protected by the Buckley
Amendment of Family Educational Rights and Privacy Act of 1974.
____________________________________________ ___________________________
Signature of Individual Date
Transcripts are $10.00 each. If requesting more than one official transcript, please include that
somewhere on this form. Please allow 2-3 weeks for processing.
METHOD OF PAYMENT
Check/Money Order (Payable to LSU FETI)
Credit/Debit Card
* For security purposes, we will contact you via phone to obtain card
information. Please provide the following contact information:
_________________________________
Contact Name
_________________________________
Contact Phone Number
Please return form and payment to:
LSU Carrol L Herring
Fire & Emergency Training Institute
Certification Office
6868 Nicholson Dr.
Baton Rouge, LA 70820
Telephone: 225-334-6282
Fax: 225-334-6065
Email: feticert@lsu.edu
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