Please complete, sign and then mail, fax, email or deliver in person to the above address.
_________________________________________________________________________________________________
UM-Flint Student ID Number Community College Student Number Birth date
(mm/dd/yy)
_________________________________________________________________________________________________
Last Name First Middle Former (If Applicable)
_________________________________________________________________________________________________
Current Street Address Uniqname
_________________________________________________________________________________________________
City State Zip Telephone
Requests completed using this form will be sent automatically to ST CLAIR COUNTY COMMUNITY COLLEGE
My signature below is agreement that:
I understand the FERPA statement and agree to my student records being shared between UM-Flint and St. Clair County
Community College for the purpose of credit evaluation to determine the awarding of an Associate Degree from St. Clair
County Community College.
If applicable, an appropriate Associate Degree will be awarded based on my records, requirements of the degree, and credits
toward degree. The awarded Associate Degree may not be the degree I was pursuing while a student at St. Clair County
Community College.
If it is appropriate to award an Associate Degree, my signature below gives permission to St. Clair County Community
College to award the degree and notify me of the results without further intervention on my part.
Please note that if you were to return to SC4 to pursue another degree, there may be financial aid implications due to the
number of credit hours attempted.
___________________________________________________________ ____________________________________
Signature Today’s Date
OFFICE USE ONLY – REVERSE TRANSFER AGREEMENT: Revised:December 11, 2012
CHECKED FOR HOLDS ____________ STAFF INITIALS ____________
REVERSE TRANSFER AGREEMENT
UNIVERSITY OF MICHIGAN-FLINT and ST. CLAIR COUNTY COMMUNITY COLLEGE
OFFICE OF THE REGISTRAR
266 University Pavilion
Flint, MI 48502
(810) 762-3344 FAX (810) 762-3346
The Family Rights and Privacy Act (FERPA) of 1974, protects the privacy of student educational records, including transcripts, by
placing certain restrictions on the disclosure of that information. As a result, your written authorization is required in order for the
University of Michigan-Flint to release your educational records to facilitate the reverse transfer credit agreement with St. Clair
County Community College.
I authorize the release of my academic records to St. Clair County Community College and the release of academic records
maintained by St. Clair County Community College to UM-Flint without prior notice and for the purpose of credit evaluation to
determine the awarding of an associate’s degree or other credential of value from St. Clair County Community College. This
authorization will remain in effect for one-year from the date of the authorization below unless revoked in writing. I understand
that I have the right to rescind this at any time by notifying the Office of the Registrar at the University of Michigan-Flint in
writing of my decision. I understand that such revocation will not affect any disclosures previously made before receipt of any
