Revised July, 2016 Academic Year 2016-17
Reverse Transfer Degree Audit
Registrar Office ∙ Building 3 ∙ 7390 South Sixth Street ∙ Klamath Falls, OR 97603
Last Name
First Name
Middle Int.
KCC ID (if known)
Mailing
Address
Street Address
City/Town
State
DOB: mm/dd/yyyy
Email Address
Phone Number
( )
____ I would like Klamath Community College (KCC) to check if I am eligible to receive my Associate’s Degree in:
(Ex: AAOT; Associate of Applied Science; etc.)
List all Colleges or Universities official transcript provided for evaluation:
_____________________________________________________ _________________________________________________
_____________________________________________________ _________________________________________________
* If you are requesting KCC to evaluate transcripts from other colleges, you must have an official transcript from each college sent to:
Klamath Community College
Attn: Transcript Evaluation Specialist
7390 S. 6
th
St.
Klamath Falls, OR 97603
By signing below, I grant permission for KCC to exchange pertinent information between the institutions. I understand that my
participation in this program will in no way have a negative effect on my status or academic standing at KCC.
_________________________________________________ ________________________________
Student Signature Date
Office Use Only
Received By: ___________ Date: ________
click to sign
signature
click to edit
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