Reverse Transfer Associate Degree Form
Student Signature Date
Records 12 5 2017
The Reverse Transfer program allows qualified students to earn an associate degree while working toward
their bachelor’s degree at the University of Baltimore. If a student is in good academic standing at both UB
and the community college (2.0 GPA), and they have completed 15 credits at the community college, they
can transfer courses completed at UB back to the previously attended Maryland public community college,
for evaluation toward the associate degree. If approved, the associate degree will be conferred by the
community college.
Complete, sign and return this release form to:
Student name: ____________________________________________ UB Student ID number: ___________________
Major at UB: ______________________________________________ UB Student email: ________________________
Community College name: ___________________________________ CC Student ID number: ___________________
Community College enrollment start date: (sem. /year) ____________Last enrolled date: (sem. /year) _____________
Do you plan to transfer additional credits from other colleges to the community college? __yes __no
If yes, from which college(s)? _________________________________________________________________________
By signing this agreement you grant the community college permission to:
Reactivate your record, if it has been two years since you last attended.
Update your address, if it has changed.
Change your major and/or catalog year to one that allows you to graduate, if you have not met the
requirements for the major indicated above.
List any former names: ___________________________________________________________________________
Print name as it should appear on the diploma or certificate (legal name only; no titles; indicate punctuation):
First: ______________________________ Middle: _______________________ Last: ________________________
Mailing Address: ________________________________________________ Date of Birth: ____________________
City: ________________________________ State: ________________________ Zip: ________________________
Phone: ______________________________ E-mail:____________________________________________________
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the
privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S.
Department of Education. In accordance with FERPA, it is the policy of UB and the community college to withhold certain
educational records unless the student provides consent to disclose information. The purpose of this form is to provide the
consent to UB and the community college required by FERPA.
I, the undersigned, hereby understand and authorize UB and the community college to release, discuss educational records and
information and agree to my student records being shared between UB and the community college for the purposes of credit
evaluation to award a degree, diploma or certificate, if I am eligible to graduate. I also understand that the awarding of an
Associate’s Degree beyond initial matriculation at UB does not alter the general education requirement status determined at
initial admission to UB.The release does not permit the disclosure of these records to any other person or entities without my
written consent or as permitted by law. This release form is effective from the date of signature below and consent remains in
effect until receipt of written revocation.
UB Records and Registration
OR Scan and submit via email /fax
1420 N. Charles Street AC 126
Baltimore, MD 21201
FAX: 410-837-4820
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