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# PC 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 @ PC PC 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 PC, and the release of any additional academic records from PC 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 Registrar at Eastern Illinois University.
I understand the FERPA statement and agree to my student records being shared between EIU and PC for the purpose
of credit evaluation to determine the awarding of an Associate Degree from PC. This form also confirms my intention
to graduate from PC if/when I’ve met the Associate Degree requirements.
STUDENT SIGNATURE: _____________________________________________________ ___ DATE: ___________________
A COPY OF THIS FROM WILL BE TRANSMITTED WITH THE OFFICIAL TRANSCRIPTS
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