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:
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
click to sign
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome