Transcript Release Permission with NICC

Transcript Release Permission
This Transcript Release Permission form is for Emmaus students concurrently enrolled in Nursing or other Health Science programs offered between Emmaus Bible College (EBC) and Northeast Iowa Community College (NICC)
Student's Full Name*

FirstLast
Student's EBC Email*
example@example.com
NICC Student ID#:
I hereby authorize Northeast Iowa Community College (UD) and Emmaus Bible College (EBC) to share my official and/or unofficial transcripts and student schedules with each other. NICC and Emmaus Bible College transcripts and student schedules will be released without charge upon request from either college for the purpose of the Concurrent Enrollment in the Dental Assistant, Medical Assistant, Nursing, Paramedic, Radiologic Technology, or Respiratory Care program. This agreement will expire once I am no longer an NICC or Emmaus Bible College student or upon my request to do so.
Student's Signature*

Clear
Jani Email
example@example.com
Should be Empty: