Reverse Transfer Application

Reverse Transfer Application
Full Legal Name:*

First NameMiddle NameLast Name
Name

First NameMiddle NameLast Name
LOLA/Banner ID*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing this agreement, you grant Fletcher Technical Community College permission to:
- Reactivate your student/academic record, if it has been more than two years since you last attended
- Update your address, email, and phone number
- Change your program/major and/or catalog term to one that allows you to graduate
- Evaluate transcript(s) and transfer applicable credit to complete your degree
Please list all college's you have attended:
Please provide your name as it should appear on the diploma/certificate:*
FERPA Statement

FERPA (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. In accordance with FERPA, it is the policy of Fletcher Technical Community College to withhold certain educational records unless the student provides consent to disclose information.

I, the undersigned, hereby understand and authorize Fletcher Technical Community College to perform a credit evaluation of my classes at Fletcher Technical Community College as well as classes completed at the above noted college(s) to award a degree or certificate, if I am eligible to graduate.

This release does not permit the disclosure of these records to any other persons or entities without my written consent or as permitted by law. This release form is effective from the date of signature below and consent remains in effect until receipt of written revocation.
Signature*

Clear
Date*

MonthDayYear
Date
For more information, please contact graduation@fletcher.edu
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