Fillable Reverse Transfer FORM19 - Reverse Transfer Transcript Release.pages

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Reverse Transfer FORM19 - Reverse Transfer Transcript Release.pages

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Updated 12/2018
Saint Louis University
Reverse Transfer
Transcript and Record Release
Form
#19
Enrollment Services Center - DuBourg Hall, Room 119
1 Grand Blvd. St. Louis, MO 63103 314.977.2269 www.slu.edu/questions
Section 2
Institution
Last Enrolled (fall/spring/summer and year)
1. Student completes sections 1 and 2.
2. Student acknowledges policies related to transcript and student records release in section 3.
3. Student submits form to the Office of the University Registrar.
4. The Office of the University Registrar coordinates with listed institution on Reverse Transfer
options.
Form Procedures
Section 1
Student
Student ID
Section 3
Signature
Student Signature
Date
✴
In accordance with the Family Educational Rights and Privacy Act (FERPA), I understand
that my educational records cannot be released without my written permission.
✴ I authorize the release of my academic records from Saint Louis University to the above
listed institution, and the release of any additional academic records from the listed
institution to Saint Louis University for the purposes of credit evaluation to determine the
awarding of an associate’s degree from the listed institution.
✴
I understand that I have the right to rescind this release agreement related to releasing my
academic records at any time by notifying the Office of the University Registrar at Saint
Louis University in writing.
I understand and acknowledge that:
Former Institution Name
Institution Website
State
Student ID at former Institution
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Completed 19 March 2020

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