Fill - Free fillable Form 2175813511: REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE EasternIllinoisUniversity OfficeoftheRegistrar 600LincolnAvenue Charleston,IL61920 (Eastern Illinois University) PDF form

ReverseTransferTranscriptRequest/Release(RTTR/R)



 REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE

  EasternIllinoisUniversity

OfficeoftheRegistrar

600LincolnAvenue

Charleston,IL61920

217‐581‐3511

217‐581‐3412FAX

records@eiu.edu



Pleasecomplete,signandthenmail,fax,emailordeliverinpersontotheaboveaddress:



EIUStudentE#    DACCStudentID#   BirthDate(mm/dd/yy)



LastName  First  MiddleFormer/Maiden(ifApplicable)



CurrentStreetAddressEIUStudentEmailAddress



CityState  Zip Telephone



LastCompletedTerm@EIU LastCompletedTerm@DACC DACCStudentEmailAddress



FERPAStatement:

UndertheFamilyEducationalRightsandPrivacyAct(FERPA)of1974,updatedJanuary2009,Iunderstand thatmy

educationalrecordscannotbereleasedwithoutmypermission.Iauthorize thereleaseofmyacademicrecordsfrom

EIUtoDACC,andthereleaseofanyadditionalacademicrecordsfromDACCtoEIU,in

ordertosharestudentdata

informationbetweenthetwoinstitutionswithouttheviolationofFERPA.IunderstandthatIhavetherighttorescind

thisreleaseagreementofmyacademicrecordsatanytimebynotifyingtheReg istraratEasternIllinois University.



IunderstandtheFERPAstatementandagreeto

mystudentrecordsbeingsharedbetweenEIUandDACCforthe

purposeofcreditevaluationtodeterminetheawardingofanAssociateDegreefromDACC.Thisformalsoconfirms

myintentiontograduatefromDACCif/whenI’vemettheASA(AssociateinScienceandArts)transferdegree

requirements.(Note:StudentswhohavecompletedtheirAES(AssociateinEngineeringScience)shouldnotcomplete



thisform.)



STUDENTSIGNATURE:________________________________________________________ DATE:___________________



ACOPYOFTHISFORMWILLBETRANSMITTEDWITHTHEOFFICIALTRANSCRIPTS



Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Form 2175813511: REVERSETRANSFERTRANSCRIPTREQUESTRELEASE EasternIllinoisUniversity OfficeoftheRegistrar 600LincolnAvenue Charleston,IL61920 (Eastern Illinois University)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Form 2175813511: REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE EasternIllinoisUniversity OfficeoftheRegistrar 600LincolnAvenue Charleston,IL61920 (Eastern Illinois University) Form

Related forms

Fillable Form 2175813511: REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE EasternIllinoisUniversity OfficeoftheRegistrar 600LincolnAvenue Charleston,IL61920 (Eastern Illinois University)

Fill Online, Printable, Fillable, Blank Form 2175813511: REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE EasternIllinoisUniversity OfficeoftheRegistrar 600LincolnAvenue Charleston,IL61920 (Eastern Illinois University) Form

Related forms

First 20 documents completely FREE!