College connect connect-to-connect transfer

COLLEGE CONNECT

CONNECT-TO-CONNECT TRANSFER

Personal Information

Social Security#____________________ SUSLA ID: 9000________________ Date of Birth_____\______\_______

Name___________________________________________ Email __________________________________________

Cell Phone:__________________________ Alternate Phone:_______________________________________

Currently Enrolled Students

I am currently enrolled in the following SUSLA College Connect Program:

□ Southern University-Baton Rouge (SUBR) □ Southern University-New Orleans (SUNO)
I am requesting a TRANSFER TO the following SUSLA College Connect Program next semester:

□ Southern University-Baton Rouge (SUBR) □ Southern University-New Orleans (SUNO)

Previously Enrolled Students

My last enrollment in SUSLA College Connect was: □ Fall ____ □ Spring _____ □ Summer _______

I am requesting a TRANSFER TO the following SUSLA College Connect Program upon readmission:

□ Southern University-Baton Rouge (SUBR) □ Southern University-New Orleans (SUNO)

I authorize the release of my transcripts and any other documents necessary to facilitate this transfer request. I understand that the same terms and conditions of the SUSLA Connect Program from my previous school are in effect when I transfer. I understand that it is at the discretion of the Connect Coordinator to grant this request, and I will be notified of his/her decision prior to the start of the semester of my request.

Signature________________________________________ Date______________________________

For Office Use Only

Approvals

Signature ________________________________ Signature _________________________________

SUNO Connect Coordinator SUBR Connect Coordinator
Signature __________________________________________________

Academic Outreach Director/SU Connect Liaison

Processors

Signature ________________________________ Signature _________________________________

SUSLA Admissions (Readmits) SUSLA Registrar (Current)
Date Processed in Banner: __________________ Processed by: ______________________________
Copy: SUNO Connect • SUBR Connect • SUSLA Admissions • SUSLA Registrar

12/2014

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