OFFICE USE ONLY
Staff Initials Date Completed
Complete, sign and return form to:
Louisiana Tech University
Office of the University Registrar
P.O. Box 3155, 207 Keeny Hall
Ruston, LA 71273
Email to:
registrar@latech.edu
VERIFICATION REQUEST FORM
Date:
Last Name: First Name: Middle Initial:
Campus Wide ID Number: Student’s Phone Number:
Expected Graduation Date:
Quarter of Verification Check one of the following:
Fall Enrollment Verification
Winter Letter for Good Student Discount”
Spring Letter of Academic Standing
Summer Complete Attached Form
Letter of Non-Attendance (Provide the following :)
Date of Birth: Last 4 digits SS#:
Mail Email Please indicate one of the following return options: Pick Up**
**Name of designated person to pick up documentation: (Identification is required):
If you selected mail or email, please provide the information below:
Email Address:
Mailing Contact Name:
Mailing Address:
City: State:
Zip Code:
Student’s Signature: (Required for release of information) Date
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