FGCU Form

Florida Gulf Coast University & Florida College System Institutions Reverse Transfer Program Application & FERPA Authorization

Our records indicate you made progress toward an Associate in Arts (AA) degree at a Florida State College before transferring to FGCU. You may be able to complete the final AA degree requirements at FGCU, while completing courses toward your Bachelor’s Degree. To find out if you qualify to request certification of your AA degree by a Florida College System, complete this Reverse Transfer Program Application to authorize sharing of your academic transcripts between FGCU and a Florida College System.

Applicant

Name*

First Name

Last Name

UIN:*

Date of Birth:*

Contact Information

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Florida College Systems Information

Name of Previous Florida State College:*

Student ID #:

Dates of Attendance and Institution:

FGCU Information

Student ID #:

Acknowledgement of Consent*

I consent to the sharing of my personal information (as provided above) and academic transcript between the institutions (as provided above) for my participation in the Reverse Transfer Program, in compliance with the Family Education Rights and Privacy Act (FERPA), 20 U.S.C. 1232g, 1974]. I understand that graduation at a Florida College System is an automatic process, streamlining the necessary steps for students and ensuring their transcripts reflect the degree or certificate earned. Thus, students will be graduated upon completing all degree requirements. I consent to having my Florida College Systems catalog year updated for purpose of graduation.

Opt-Out Option:

At this time, I “OPT OUT” of the Reverse Transfer Program.

Electronic Signature*

[clear]

Use your mouse or finger to draw your signature above

Date