(Electronic signature or type your name)
A
UTHORIZA
TION
I
authorize
the release and sharing of my
academic records
and student
information between the
University of Maine
System
and the
Maine Community College System
for the purpose of credit evaluation to determine the awarding of
an Associate degree or Certificate.
This information will be released without prior
notice, and the
authorization
will
remain in
effect for three years
from
the
da
t
e
below
unless
revoked
in
writing.
I
understand
that
I have the
right to
rescind this
authorization at
any
time
by
notifying
the
contact person at the university
in
writing
of my
decision.
I
understand
that
such
revocation
will not
affect
any
disclosures previously
made
before receipt
of
an
y
such
written
r
e
v
oca
tion.
My
signature below
is
agreement
tha
t:
•
I
understand
the FERPA
s
ta
t
ement
and the
authorization,
and agree
to
my
student records and
information
being
shared and
communication about
my
records between
university and the
community college for
the
purpose
of
credit evaluation
to determine
the
awarding
of an As
socia
t
e
degree
or
Certificate
.
•
I have read all of the
information
on this
application
and the FAQ’s and I
accept that it is my responsibility to
complete all of the required courses for the
credential
for
which I am
applying.
•
If
applicable
,
an
appr
opria
t
e
As
socia
t
e
degree
will be
awarded
by the
community college
based on
m
y
records,
requirements
of the
degr
ee
,
and
credits toward degr
ee
.
The
awarded
As
socia
t
e
degree
ma
y
not be the
degree
I
was
pursuing
while a
student at
the
community c
ollege.
•
If
it
is
appr
opria
t
e
to award
an As
socia
t
e
degr
ee or Certificate
,
my
signature below
gives
permission
to the
community college to award
the
credential once all requirements are completed
and
notify
me of the results
.
Signa
tur
e
T
oday’
s
Da
t
e
NOTE: Your
signature on
this
form authorizes
the release of your
transcript
as well as our
ability to
c
ommunica
t
e
with
you and between the MCCS and UMS
about
this
r
eques
t
via e-mail or
phone
.
Forms
without signatures
will not
be
pr
oc
es
sed.
Sign
completed
reques
t
and then mail,
fax,
email, or
deliver
in
person
to
the appropriate contact person below:
University of Maine
Kathleen M. Ouellette
University of Maine
Wingate Hall
Orono, Maine 04469
Phone (207) 581-1319
Fax (207) 581-1314
Kathy_M_Ouellette@umit.maine.edu
University of Maine at Augusta
Katherine Trask
46 University Drive
Augusta, ME 04330
Phone (207) 621-3333
Fax (207) 621-3061
www.uma.edu
University of Maine at Farmington
Mitchell Bean
University of Maine at Farmington
224 Main Street
Farmington, ME 04938
Phone (207) 778-7735
Fax (207) 778-8182
mitchell.bean@maine.edu
University of Maine at Fort Kent
Jill Bouchard Cairns
23 University Drive
Fort Kent, ME 04743
Phone (207) 834-7600
Fax (207) 834-7609
jillb@maine.edu
University of Maine at Machias
Christy Alley
116 O'Brien Ave
Machias, ME 04654-1397
Phone (207) 255-1268
Fax (207) 255-1474
christy.alley@maine.edu
University of Maine at Presque Isle
Erin Benson
181 Main Street
Presque Isle, ME 04769
Phone (207) 768-9453
Fax (207) 768.9777
erin.benson@umpi.edu
University of Southern Maine
Suzanne Turner
37 College Avenue
Admission Annex
Gorham, ME 04038
Phone (207) 780-5691
Fax (207) 780-5511
transferusm@maine.edu
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