Fill - Free fillable REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE Lake Forest College Office of the Registrar PDF form

10/1/2019

REVERSETRANSFERTRANSCRIPTREQUEST/RELEASE

Lake Forest College

Office of the Registrar

555 N. Sheridan Rd

Lake Forest, IL 60045

registrar@lakeforest.edu

847-735-5025

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

Community College Attended Lake Forest Student ID#

BirthDate(mm/dd/yy)

LastName First Middle

Former(ifApplicable)

CurrentStreetAddress

Lake ForestStudent EmailAddress

City State Zip Telephone

LastCompletedTerm@Lake

Forest College

LastCompletedTerm@Community

College

Community College ID#

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

Lake Forest Collegetothe Community College,andthereleaseofanyadditionalacademicrecordsfromthe

Community College to Lake Forest College, 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Lake Forest College.

IunderstandtheFERPAstatementandagreetomystudentrecordsbeingsharedbetweenLake Forest Collegeand

the Community CollegeforthepurposeofcreditevaluationtodeterminetheawardingofanAssociateDegreefrom

the Community College.Thisformalsoconfirmsmyintentiontograduatefromthe Community Collegeif/whenI’ve

mettheAssociateDegreerequirements.

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

A copy of this form will be mailed to the Community College together with the Lake Forest College transcript

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REVERSETRANSFERTRANSCRIPTREQUESTRELEASE Lake Forest College Office of the Registrar

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