TRANSFER CLEARANCE FORM

TRANSFER CLEARANCE FORM
By receiving this form, the transfering student has authorized you to disclose all records relating to any misconduct they engaged in during their time at your instituation.

This is a non-academic report form for students wishing to transfer to West Virginia Wesleyan College. Completion of this form is necessary in order for a student to register for classes. This form must be submitted after enrollment is completed at the student's previous institution.
Transferring Student's Name: *

First Name Last Name
According to your records, has the above student been suspended or expelled for non-academic reasons? *
Date of suspension or expulsion: *
When is the student eligible to return to your institution? *
Is this student eligible to continue at your institution? *
Information of School Official Completing Form
School Official's Name: *

First Name Last Name
School Official's Title: *
School Official's Email: *
example@example.com
School Official's Phone Number *
Please enter a valid phone number.
Signature *

Clear
Date *

Month Day Year
Date
Should be Empty:

Information of School Official Completing Form