LETTER REQUEST

75 University Avenue Wes, Waterloo, Ontario, Canada N2L 3C5

Telephone: (519) 884-1970 Fax: (519) 884-8826

Print Names and full mailing addresses with postal codes clearly. These forms will be used for mailing your letters.
Complete request form and Mailing Label(s) before submitting. Include payment of $12.00. Cheques payable to WLU.
For credit card payment ONLY faxes are accepted (519-884-8826). Please fax one time only per request. If the credit
card information is incomplete or declined, the form will be returned. Request will not be processed without payment.
STUDENT INFORMATION:

Release Instructions

W LU Student N um ber ___________________________________

Last N am e

____________________________________

First N am e

____________________________________

Form er Last N am e

_ _____________________________________

D ate of Birth

____ ____ ____

D ay

C urrent Address
(For m ailing letter)

M onth

___ Total Num ber

of Copies
(Maxim um of 5
copies):

Y ear

____________________________________
_____________________________________

E m ail A ddress
__________________________________________
_________________________________________
D aytim e Telephone

Mail

Office Use Only:

Cash
Cheque
Money Order
Am ount Received

Pick-up
(confirm date with
staff) For Reception
drop off only.
______

Date sent

(______) ______________________________

CREDIT CARD PAYMENT:

VISA ____ MASTERCARD ____
CARDHOLDERS NAME:______________________________________
CREDIT CARD NUMBER: _____________________________________
EXPIRY DATE: _______ /_______
LIS T M ailing address(es) B E LO W ( nam e/com pany only): N O TE : W hen choosing options fax and courier, rem em ber to include correct paym ent.
N A M E (C ontact nam e and Fax N um ber for Faxes) (refer to Form s on 2 nd page)

Fax ($6.00
extra)

C ourier [Additional C harges A pply]

(O ntario: $5.00, O ut-of-P rovince: $15.00, U .S .A .:
$20.00, O verseas: $30.00)

I require the following:

Letter stating full-time/part-time attendance for the 20____ to 20 ____ year at WLU for the 1st 2nd 3rd 4th(honours
only) year in the________________________________________________________________program.
OR
A letter stating the following: ___________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
S tatem ent w ill be verified by the O ffice of the Registrar prior to release.
This information is collected under the authority of the Wilfrid Laurier University Act to administer the university-student relationship. This includes but is not limited to maintaining
your academic and ancillary records, contacting you, and others on your behalf, and releasing such information as is appropriate for the operation of the university. Consult the
Privacy Co-ordinators webpage www.wlu.ca/privacy for potential uses of your personal information. Privacy question may be directed to privacy@wlu.ca.

S tudent Signature ____________________________________________________ D ate Signed _________________________________________

Mailing Labels

(Please fill out as required)

Wilfrid Laurier University

Office of the Registrar
75 University Avenue West
Waterloo, ON N2L 3C5

S T U D E N T IN FO R M A T IO N

S tudents N am e __________________________________________________

W LU S tudent N um ber

__________________________

A dditional C om m ents for label:

Print N am e and A ddress A bove

Please forward ______ ____

letter/transcript(s) to the above add ress.

Wilfrid Laurier University

Office of the Registrar
75 University Avenue West
Waterloo, ON N2L 3C5
S T U D E N T IN FO R M A T IO N
S tudents N am e

__________________________________________________

W LU Student N um ber ___________________________________

Additional C om m ents for label:

Print N am e and A ddress A bove

Please forward __________ letter/transcript(s) to the above address.

Wilfrid Laurier University

Office of the Registrar
75 University Avenue West
Waterloo, ON N2L 3C5
ST U D E N T IN FO R M A T IO N
S tudents N am e __________________________________________________

W LU Student N um ber ____________________________________

A dditional C om m ents for label:

Print N am e and A ddress A bove

Please forward ______ _____ letter/transcript(s) to the above add ress.