Tennessee Tech | Office of the Registrar | Jere Whitson Building, Room 221 | 931.372.3317 | registrar@tntech.edu | tntech.edu/em/records/
Office of the Registrar
TENNESSEE TECH
To Custodian of Records:
Student Name: ______________________________________________________ T#: __________________________
(Last) (First) (MI)
Previous Last Name: __________________ Phone: _________________ Email: ______________________
Current Street Address: ____________________________________________________________________
(Street Number & Street Name) (City) (State) (Zip)
Date of Birth: _____________________ Are you currently enrolled at TTU? Yes No ______________________
(List Dates of Attendance)
“I wish to inspect my education record located within the following office(s) listed below:”
____________________ _____________________ _________________
Student Signature: ______________________________________________ Date: _____________________
To Student: Your request for inspection of your record was received on ________. The requested record will be available
at __________________________ on ___________________.
School Official Signature: __________________________________________ Date: ____________________
To Custodian of Records: I have inspected or have been informed by the contents of the requested education record
identified above and am satisfied with its accuracy and completeness.
Student Signature: ______________________________________________ Date: _____________________
To Custodian of Records: I have inspected or have been informed by the contents of the requested education record
identified above and am not satisfied with its accuracy and completeness for the following reasons:
________________________________________________________________________________.
Student Signature: ______________________________________________ Date: _____________________
This form may not be submitted electronically. Requests must be made in person with valid photo ID. Questions about this policy and
procedure may be directed to the Office of the Registrar. Students wishing to have their education records amended must submit a
formal letter to the Office of the Registrar.
Record Custodian’s Signature: _____________________________________ Date: _____________________
