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Student Records Request

Loudon County Schools

Please send the completed form via postal mail, fax, or email to:

Lacey Orr, District Records Coordinator

Fax: 865-988-7775

Loudon County Technology Center, 4380 Harrison Road, Lenoir City, TN 37771

Date*

Answer Required

Student Name (First and Last)*

Answer Required

Student Maiden Name (if applicable)

Answer Required

Date of Birth*

Answer Required

Student Graduation Year*

Answer Required

School Graduated From*

Answer Required

Phone Number*

Number Required

Email Address*

Answer Required

I hereby authorize Loudon County Schools to send records to the following institution:

Institution Name*

Answer Required

Institution Address

Institution Street Address

Answer Required

Institution City

Answer Required

Institution Zip/Postal

Answer Required

Institution Address 2

Institution Street Address

Answer Required

Institution City

Answer Required

Institution Zip/Postal

Answer Required

Institution Email (if applicable)*

Answer Required

Institution Fax (if applicable)

Number Required

Confirmation Email

Confirmation Email *

Email Required