Fillable Application for Reverse Transfer (Erie Community College)

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Application for Reverse Transfer (Erie Community College)

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The Application for Reverse Transfer (Erie Community College) form is 2 pages long and contains:

  • 1 signature
  • 14 check-boxes
  • 44 other fields

Country of origin: US
File type: PDF

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Application for Reverse Transfer
SUNY Erie Community College - Reverse Transfer Office
6205 Main Street
Williamsville, NY 14221
Phone: 716-270-4698 Fax: 716-851-1272
cammillerir@ecc.edu
Please complete this form and fax or mail to the address above.
SECTION I
1. Name
Last First Middle
2. Social Security Number (last 4 digits) _________________ or SUNY Erie ID#_____________________
3. If your education records were filed under a different name, show former or maiden name:
4. Home Address
Number Street Apt. No.
City State County Zip
Telephone Email Address
5. Date of Birth Male Female
Month / Day / Year
6. Degree you would like to be evaluated for:
7. Applying for Graduation in: Spring
Liberal Arts-General Studies (250.GST)
Other
8. If eligible for a degree, do you plan to participate in the May graduation ceremony? YES NO
SECTION II
COLLEGES ATTENDED:
Please note that accepting a certificate or degree could impact your financial aid if you are taking classes or plan to take
classes in the future. Please contact your Financial Aid representative if applicable.
over
DATES ATTENDED
Name
Address (City and State)
From
mo / year
To
mo / year
Did you get
a degree?
Degree name
Summer
Fall
I hereby acknowledge by signing this document of application to SUNY Erie Community College that I will be held personally
and legally responsible for any debts or liabilities incurred at the institution. Financial obligations may include all tuition
liabilities, fees, books, child care and other extraneous costs. If legal action must be taken for restitution, I will be responsible
for all collection and legal costs.
Signature: _____________________________________________ Date: __________________
Graduation Approval:
SECTION III: FOR OFFICIAL COLLEGE USE ONLY
To Be Completed by Academic Department
GRADUATE'S CURRICULUM (MAJOR):
CHECK ONE: CERTIFICATE DEGREE: AAS AA AS AOS
Certified as meeting preliminary requirements pending review and successful completion of current semester courses, as well as
meeting all other requirements for the curriculum as listed in the catalog.
(CURRICULUM COORDINATOR/DEPARTMENT HEAD SIGNATURE)
To Be Completed by Registrar
Date Received: Initials:
Fall 2018
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Application for Reverse Transfer (Erie Community College)

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Completed 29 January 2021

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