This Permission to Transfer form is for students currently enrolled at another college or university
who wish to take courses at RACC for transfer purposes only. This form must be signed by the
Registrar or other designated official at your current college or university. For questions, please
contact the Record Office at 610.607.6243. Return completed form to the Records Office, Berks
Hall, Room 107, fax to 610.607.6290 or email form to
Name: ______________________________________________ RACC ID or SSN#: _______________________________
Email: _________________________________ Phone #: ___________________________ Date of Birth: ________
Home Address: _______________________________________________________________________________________
Current college or university: ___________________________________________________________________________
I am requesting permission to take courses at RACC for transfer credit in:
o Summer 20____ o Fall 20 ____ o Winter Interim 20 ____ o Spring 20 ____
The following secTion is To be compleTed by The RegisTRaR oR oTheR designaTed official aT The cuRRenT college oR univeRsiTy:
I affirm that this student is in good standing at ___________________________________________ and has
permission to take the following courses at RACC for transfer back to this institution:
RACC CouRse # # of CRedits dAys times CouRse equivAlent
__ __ __ - __ __ __ - __ __ __ __ ______ ______ ________________ ____________________________
__ __ __ - __ __ __ - __ __ __ __ ______ ______ ________________ ____________________________
__ __ __ - __ __ __ - __ __ __ __ ______ ______ ________________ ____________________________
__ __ __ - __ __ __ - __ __ __ __ ______ ______ ________________ ____________________________
Registrar or authorized official’s signature:
______________________________ __________________________ ____________________________ _________
Name Title Signature Date
To be compleTed by The sTudenT:
I understand that:
I am electing to take the course(s) listed above without taking the required placement test or completing any required
prerequisites at RACC.
The instructor(s) of the course(s) above will not be expected to cover information or skills taught or confirmed through
RACC’s placement test process or any required prerequisites. I assume responsibility for learning any prerequisite material
The course(s) above and the grade(s) I earn will become a part of my permanent academic record and I understand that
whatever grade(s) I earn in this course(s) may impact my future financial aid eligibility. I am responsible for requesting that an
official transcript be sent to my current college or university at the completion of this semester.
Transient students are not assigned an academic advisor.
In accordance with the policies of the Board of Trustees, I may be administratively withdrawn from the college and/or forego
such benefits as transcripts and diplomas if tuition charges, fees and any other financial obligations are not fulfilled in an
agreed upon manner. I acknowledge my financial responsibility even though I may receive financial aid or other educational
assistance to discharge this obligation. I agree to pay all costs and charges necessary for the collection of any amount not paid
when due. I also agree to pay all attorney’s fees and/or legal fees and court costs.
Student Signature: __________________________________________________________________ Date: ________________________
GAP 03/16
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome