Dean's Certifications & Disciplinary Records Request

General Information

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of Request(Required):

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Your Information

Please complete these fields. If you do not know your Lehigh ID Number, you can leave that blank. The contact information is vital in case we need to contact you.

Name

Lehigh ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Information for Records Release

Click here for more Information on Lehigh University's Disciplinary Records Release Policy

Dates of Attendance at Lehigh University (YYYY-MM-DD) to (YYYY-MM-DD).(Required) This field is required.

Did you graduate from Lehigh University?(Required)

Yes No Current Student Unsure

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Please list the names, addresses, contact information (including email) of EACH of the Institutions that you are requesting reports be sent to. If you want these records sent to you, please indicate how you would like these records sent.(Required) This field is required.

Is your current name, the same name you had while attending Lehigh?(Required)

Yes No

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If, No what was your name while attending Lehigh? This field is required.

Additional Information, Requests, or Comments: This field is required.

I understand that this consent shall only be valid for this particular request. Further requests will require additional consent.(Required)

Yes No

You must make at least one selection.

Supporting Documentation

Please be sure to complete, sign, and attach the following documents to ensure timely completion of your request.

* Any documents/forms from the institutions to which you want us to send a report.
* A photograph of a government issued I.D. of some kind that includes a photograph(passport, drivers license, etc.)

Additional information concerning Lehigh University's Records Retention and Release Policy can be found online here. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

General Information

Your Information

Information for Records Release

Supporting Documentation

Submission