Fillable Reverse Transfer Agreement Form (Parkland College)

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Reverse Transfer Agreement Form (Parkland College)

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The Reverse Transfer Agreement Form (Parkland College) form is 1 page long and contains:

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  • 0 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Parkland College

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Reverse Transfer Agreement Form
_______________________________ ______________________________
1. Parkland Student ID
2. Birth Date
_______________________________
______________________________
3. Last Name
4. Current Street Address
_______________________________
______________________________
5. First Name
6. State & Zip Code
_______________________________
______________________________
7. Middle Name
8. Telephone
_______________________________
______________________________
9. Personal Email
10. Year(s) Attended
_______________________________
______________________________
11. Title of Program
12. Program Code
_______________________________
______________________________
13. Diploma Mailing Address
14. State & Zip Code
FERPA Statement:
Under the Family Educational Rights and Privacy ACT (FERPA) of 1974, updated January 2009, I
understand that my educations records cannot be released without my written permission. I authorize
the release of my academic records from ____________ University/College to Parkland College, and the
release of any additional academic records from Parkland College to ____________ University/College,
in order to share student data information between the two institutions without a violation of FERPA.
Student signature: ________________________________________________________
Date: ___________________________________________________________________
Office Use Only
Final Graduation Information
Program/Cumulative GPA: _________________ Activate CRI: ________________________
Graduation with Honors: __________________ Email to Student: ____________________
Degree Posted: __________________________
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Reverse Transfer Agreement Form (Parkland College)

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Completed 15 September 2020

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