Form F-406 - Receipt Of Internal Transfer Form

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RECEIPT OF INTERNAL TRANSFER FORM
(Completed by receiving center dean’s office)
Name_________________________________________________________________________________________________________
Student_ID#____________________________________________________________________________________________________
Sending_center______________________________________Date_materials_from_sending_center_received_______________________
Receiving_center_ _______________________________________________________________________________________________
q The_following_items_checked_are_missing_from_the_transfer_packet._The_transfer_cannot_be_completed_until_the_entire_
_
packet_is_received._Date_of_follow-up_with_sending_center___________________.
q_ Academic_Summary_Report_(X412_report)
q_ Copies_of_all_relevant_enrollment_status_documents_(completed_evaluations,_outcomes,_learning_contracts,_notes_
_
_
regarding_any_in-progress_situations)
q_ Part_II_of_Application_for_Admission
q_ Immunization_status_of_the_student
q_ Documents_related_to_student_grievances/appeals_if_applicable_
q_ Educational_Planning_status_
q_ Degree_program_processing_status_including_assessment,_CBE_information_and_ARC_decision
q_ Student_SAP_status
q_ Student_G.P.A._status
q_ Primary_mentor’s_summary_of_student’s_performance_and_any_other_pertinent_information
The_following_items_required_for_internal_transfer_have_been_received_from_the_sending_center._The_packet_is_complete._
Date__________________
q_ Completed_Internal_Transfer_Request_Form_
q_ Completed_Internal_Transfer_Checklist,_specifically:
q_ Academic_Summary_Report_(X412_report)
q_ Copies_of_all_relevant_enrollment_status_documents_(completed_evaluations,_outcomes,_learning_contracts,_notes_
_
_
regarding_any_in-progress_situations)
q_ Part_II_of_Application_for_Admission
q_ Immunization_status_of_the_student
q_ Documents_related_to_student_grievances/appeals_if_applicable_
q_ Educational_Planning_status_
q_ Degree_program_processing_status_including_assessment,_CBE_information_and_ARC_decision
q_ Student_SAP_status
q_ Student_G.P.A._status
q_ Primary_mentor’s_summary_of_student’s_performance_and_any_other_pertinent_information
Complete_the_following_two_items_to_verify_the_internal_transfer_of_the_student.
q_ Student_transfer_to______________________________________________________________________is_accepted_and_verified.
center/unit
q_ New_primary_mentor_has_been_assigned._Mentor’s_name_ ________________________________________________________
_______________________________________________________________________ _______________________________________
Signature_of_dean_or_representative_
Date
Upon submission of Receipt of Internal Transfer Request Form to registrar, the student officially becomes affiliated with the
receiving center.
Notification of transfer to: student, sending dean and previous primary mentor.
F-406–Rev._11/2010

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