Transfer of Professional Development Courses Request
To be completed by the Student (please type or print legibly)
Date of Request: ___________________
Student Name: ________________________________________________________
Last First Middle/Former
Address: ____________________________________________________________
Street
____________________________________________________________
City State Zip
Home Phone: (______) ____-______ Daytime Phone: (______) ____-______
Area Code Number Area Code Number
Email Address:_________________________________________________________
Current Certificate Program: _____________________________________________
Education Coach: _____________________________________________________
By typing my name below I indicate I am the student named above and have read
and understand the Transfer of Professional Development Courses Policy as
outlined in the Student Handbook.
____________________________________________ _________________
Student Signature Date
(For CCEI Internal Use Only)
Student Services:
Date Received: ___________________
FAME ID#: _______________________
Enrollment Date: __________________
Transcript Reviewed : ______________
# of Courses Approved for Transfer: ___
Date Courses Transferred: ___________
Student Notified: ___________________
Approvals:
Compliance Specialist
Form CCEI-SF-PD01 (rev. 09/01/2019)
3059 Peachtree Industrial Blvd. ▪ Duluth, GA 30097 ▪ Phone 800-499-9907 ▪ Fax 866-878-3608 ▪ www.cceionline.edu
©
Copyright 2019, ChildCare Education Institute. All rights reserved. CCEI provides training and education programs and makes
no guarantee of employment, promotion, or retention.
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Sends form by email to Compliance.
Print form
and fax to (866) 878-3608.
Save copy of form and upload to
Compliance in Student Portal.
click to sign
signature
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