Reverse Transfer Opt-In/Graduation Application
Name: _______________________________________________ Date of Birth: ____________________
(Please print your name as you wish it to appear on your diploma.)
Student ID# (4-year institution): ___________________________ Last Four Digits of SS#: ____________
Home Phone: _______________________________ Cell Phone: ________________________________
Mailing Address:
_________________________________
_________________________________
_________________________________
Primary Email: _________________________________________________________________________
Current and/or Previously attended Institution:
1. ___________________________________________
2. ___________________________________________
3. ___________________________________________
4. ___________________________________________
Associate degree you are seeking: _________________________________________________________
Would you like CASC to update your CASC records to reflect address and numbers above?
Y or N
By completing this application, I authorize current and/or previous institution to release my official
transcript* to Carl Albert State College. I agree to allow Carl Albert State College to review my academic
records and post any degree for which I qualify. I understand that a final transcript* with my degree
awarded will be provided to my current 4-year institution.
Student Signature: ___________________________________________ Date: _____________________
* I understand that the institutional transcript release policy applies.