By completing the following form, you are authorizing the release of your community college transcripts to be evaluated for the Community College Reverse Transfer Program. First Name Last Name Email Address Current NDMU students should use NDMU email address. Do you have an an associate (A.A.) degree? Yes, I have an A.A. degree and am not eligible for this program. No, I do not have an A.A. degree. If you have an A.A. degree and received this invitation, then we do not have a transcript on file that bears your A.A. degree. Please forward that document to us at your earliest convenience so that we can update your file. Community college that will review reverse transfer credits: Permissions/Approvals Permissions/Approvals I would like to accept the invitation to be part of the Reverse Transfer Program. By checking below, I understand that I give permission for the following: • Notre Dame to release my NDMU transcript to the community college AND vice versa. (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.) • The community college to reactivate my academic record if it has been over two years since my last attendance • Notre Dame and the community college to consider both my original program of study as well as the general studies/interdisciplinary studies program of study to determine “best path” to graduation at the associate degree level • The community college permission to change/update my catalog year to one that allows graduation I Agree I Agree By checking this box, I allow a review of my academic record to determine my eligibility for the Reverse Transfer Program and understand that this does not guarantee associate degree completion. A final review by community college personnel of all academic work completed will determine the ability to complete the degree requirements. FERPA 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 NDMU to withhold certain educational records unless the student provides written consent to disclose information. The purpose of this form is to provide the consent to NDMU as required by FERPA.