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REVERSE TRANSFER FORM / AWARD REQUEST

Name
Mailing Address*
Birthdate MM/DD/YY*
List Colleges/Universities you have attended (Check All that Apply)
This will be used to evaluate your credits

FERPA Statement

The federal Family Educational 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 Lawson State Community College to release your educational records to facilitate the reverse transfer credit agreement.

Authorization:

I authorize the release of my academic records maintained by Lawson State Community College to the community college: and the release of my academic records maintained by said community college to Lawson State Community College without prior notice and for the purpose of credit evaluation to determine the awarding of an associate degree or other credential of value. I understand that I have the right to rescind this authorization at any time by notifying the Office of the Registrar at Lawson State Community College in writing of my decision. I understand that such revocation will not affect any disclosures previously made before receipt of any such written revocation.


My signature below is agreement that:

  • I understand the FERPA statement and the authorization, and agree to my student records being shared between Lawson State Community College and the community college for the purpose of credit evaluation to determine the awarding of an associate degree.
  • 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 the community college.
  • If it is appropriate to award an associate degree, my signature below gives permission to the community college to award the degree and notify me the results without further intervention on my part.
Use your mouse or finger to draw your signature above

Most transcript requests are processes within 24-48 hours of receipt. Your signature on this form authorizes the release of your transcript as well as our ability to communicate with you about this request via e-mail or phone.

*When possible, official transcripts will be transmitted electronically.

Date*

Confirmation Page

Thank you for your submission.   Someone will be in touch with you concerning your reverse transfer.

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