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TLE Course Transfer Request and Release Authorization
Please complete the following form to request a professional development course transfer and authorize release of your student information as required for the transfer request. 
Email *
First Name *
Last Name *
Middle Name
Street Address *
City *
State *
Zip Code *
Cell Phone Number: 555-555-5555 *
Work Phone Number: 555-555-5555
Email Address *
Current Certificate Program *
By submitting this form, I verify that I am currently or have been in the past a student enrolled in the above listed program offered by Childcare Education Institute, LLC.  

I acknowledge that as a part of my enrollment CCEI maintains certain information regarding my enrollment and completion of components of the programs. I hereby authorize CCEI, its affiliates and representatives to provide and remit to my center administration, ownership and any regional or corporate personnel associated with the management and reporting of my education and training as it relates to my job qualifications and the persons and entities listed below as 'Additional Authorized Recipients," in any method, whether in writing, orally, or electronically any and all information maintained by CCEI in connection with my enrollment, progress or completion of any program I have been enrolled in or am currently enrolled with CCEI. 

I agree to indemnify and hold harmless CCEI, its affiliates, employees, members and representatives from any and all damages, liabilities and costs and expenses that any of them may suffer as a result of any claim or action in any way related to CCEI's transmittal or disclosure of information pertaining to my enrollment in any program with CCEI in accordance with this authorization. 
 *
Required
Additional Authorized Recipient: 
Stephanie Morris
Additional Authorized  Recipient: 
Andrea Zupicich
Additional Authorized  Recipient
By typing my name below I indicate I am the student named above and have read and understand the Transfer of Professional Development Courses Policy as outlined in the Student Handbook.  
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