UH School of Nursing Records Transfer Authorization

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UH School of Nursing
Records Transfer Authorization
128 Welcome Center
Houston, Texas 77204-2027
(832) - 842 - 1010
As part of the School of Nursing transition to the University of Houston, the University will need to transfer your academic
history from University of Houston-Victoria, which requires your authorization. Please complete the form below to authorize the
transfer of your records.
Student Information
myUH ID NUMBER
LAST
FIRST
MIDDLE
CURRENT MAILING ADDRESS
CITY
ZIP CODE
STATE
DATE OF BIRTH
/
/
TELEPHONE NUMBER
(
)
‐
EMAIL ADDRESS:
Authorization and Signature
I authorize the University of Houston-Victoria to transfer my academic records to the University of Houston as part of the
transition of the School of Nursing to the University of Houston.
Signature:
Date:
State law requires that you be informed of the following: (1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form; (2) under
sections 552.021 and 552.023 of the Government Code, you are entitled to receive and review the information; and (3) under section 559.004 of the Government Code, you are entitled to have the University correct
information about you that is incorrect.
05/2015
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