Today’s date ____/____/____
This form can be used to verify that students who attend another college/university are prepared for specific KCC courses. It is only
valid for a “temporary” transfer to KCC. The assumption is that the student will return to the primary college/university and will
transfer the KCC course credits to that institution.
Once completed and signed, upload the completed document as part of the Summer Visiting Student Registration Form and Submit.
STUDENT INFORMATION
Name:
LAST FIRST MIDDLE (FULL)
Date of birth: ____/____/____
Street address:
City: State: ZIP code:
Home phone:
( )
-
Primary college/university of attendance:
Street address:
City: State: ZIP code:
COURSE INFO AND COLLEGE/UNIVERSITY VERIFICATION.
TO BE COMPLETED BY COLLEGE/UNIVERSITY REPRESENTATIVE.
Note: Full-time summer enrollment at KCC is 6 credit hours; part-time is 3 credit hours.
KCC course number(s) __________________________ _____________________ _________________________ ________________________
ex.: MATH 1774
University equivalent(s) __________________________ _____________________ _________________________ ________________________
ex.: STATS 101
Is the student named above prepared to take the course(s) listed on this form? Yes No
Term/year of enrollment at KCC:
Summer Fall Spring Year
Check one:
Approved to transfer to the above-named college/university
Not approved to transfer this course to the above-named college/university
_______________________________________________________________________________________
Phone: ( ) -
Verified by Title
_______________________________________________________________________________________
Signature Date
Kankakee Community College
Temporary Transfer Form
ADMISSIONS OFFICE
100 College Drive • Kankakee, IL
60901-6505 • 815-802-8500
/
/
Apt. #
P.O Box #
( )
Verified by College/University Representative
( )
Signature by College/University Representative
REV. 4/2017
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