Application for Transfer Credit
Last Name: _____________________________ First Name:_______________________ Middle:____________________
Former Name:____________________________ Student/ Banner ID# (or last 4 digits of SSN):_______________________
Street Address:____________________________________________ City:___________________ State:___ Zip:_______
Phone:_______________________________________ Email:_______________________________________________
Instructions: Please check the degree or certificate program toward which you wish to have transfer credit evaluated.
Return this form to ACC Admissions - Transfer Evaluation
Associate Degree Programs:
Accounting General Studies Tech. Studies: Welding Technology
Business Administration Human Services Tech. Studies: Electronics Technology
Communications Liberal Arts (AA) Tech. Studies: Machine Technology
Communications: Broadcasting Option Liberal Arts/Fine Arts (AA) Option
Communications: Journalism Option Massage Therapy Tech Studies: Electro-
Criminal Justice Registered Medical Assistant
Early Childhood Education Technology Studies
Engineering Science
Mechanical Maintenance
CSCU Transfer Ticket Programs: NOTE: These associate degree programs provide pathways for community college students to complete
degree programs that transfer to Central, Eastern, Southern, & Western Connecticut State Universities and Charter Oak State College.
Art Criminology Political Science
Biology Early Childhood Teaching Credential Psychology
Biochemistry Studies English Studies Social Work
Business Studies History Sociology
Chemistry Mathematics Spanish
Communication Physics
Certificate Programs:
Accounting Assistant Certified Phlebotomy Technician Electro-Mechanical Maintenance Cert.
Advanced Manufacturing Machine Early Childhood Education Electronics Technology
Entrepreneur Marketing
Advanced Welding Gerontology Office User Specialist
Business Administration Health Career Pathways Registered Medical Assistant
Certified Administrative Medical Health Information Management Web Designer
Office Skills Technician
Human Services Management
OTHER: ___________________________________
Previous Colleges Attended: Students must request that official transcript be sent to the Asnuntuck Community College
Admissions Office from each college previously attended. ACC can receive most official transcripts electronically.
Name of College(s) to be evaluated: Dates of Attendance:
________________________________________________________ ___________________________________________
__ ___________________________________________
__ ___________________________________________
Students Signature______________________________________________________ Date________________
Notice of Non-discrimination: Asnuntuck Community College does not discriminate on the basis of race, color, religious creed, age, sex, national origin, marital status, ancestry, present or past
history of mental disorder, learning disability or physical disability, sexual orientation, gender identity and expression or genetic information in its programs and activities. In addition, the College
does not discriminate in employment on the basis of veteran status or criminal record. The following individuals have been designated to handle inquiries regarding the non-discrimination
policies: Yhara Zelinka, Title IX Coordinator, (860) 253-3092 and Deborah Kosior, 504/ADA Coordinator, and Deborah Kosior, 504/ADA Coordinator,
AS- (860) 253-3005, Asnuntuck Community College, 170 Elm Street, Enfield, CT 06082.
Políticas Antidiscriminatorias: Asnuntuck Community College no discrimina por razones de raza, color, creencias religiosas, edad, género, nacionalidad, estado civil, ascendencia, historia
presente o pasada de discapacidad mental o física, problemas de aprendizaje, orientación sexual, Identidad y expresión de género, o información genética, en sus programas o actividades.
Adicionalmente Asnuntuck no discrimina individuos por razones pertinentes a la categoría de veteranos o historia criminal. Las siguientes personas han sido designadas para resolver cualquier
inquietud pertinente a las políticas antidiscriminatorias: Yhara Zelinka, Title IX Coordinator, (860) 253-3092 and Deborah Kosior, 504/ADA Coordinator, AS- (860) 253-3005, Asnuntuck Community College, 170 Elm Street, Enfield, CT 06082. Rev. April/2020