Transfer Form

Student Name:  

Location: LocationBowling GreenElizabethtownFlorenceHopkinsvilleLexingtonLondonOwensboroSomersetFort Myers 

Instructor:  

Program: Dental AssistantBusiness AdministrationClinical Medical AssistantElectronic Health RecordsMedical Administrative AssistantMedical Billing & CodingPharmacy TechnicianPhlebotomy TechnicianMAAEHRMAAEHRBCMAABCMAABA 

Class Day of Week: Day of WeekMondayTuesdayWednesdayThursdayFriday Time of Class: Time8:00AM - 12:00PM1:00PM - 4:00PM5:30PM - 7:30PM7:30PM - 9:30PM 

Canvas Start Date & First Day of Attendance:  

Last Date of Attendance (today's date):  

New Program: Dental AssistantBusiness AdministrationClinical Medical AssistantElectronic Health Records Medical Administrative AssistantMedical Billing & CodingPharmacy TechnicianPhlebotomy TechnicianMAAEHRMAAEHRBCMAABCMAABA 

By digital signing this document you are agreeing to and understand the TMIKY Transfer rules and regulations that have been laid out in the TMIKY Catalog. After submission this document will be sent to the proper channels for approval. Please email us at [email protected] if more guidance is needed. 

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Document name: Transfer Form

Unique Document ID: adfce4ce4c67af96cc6e9a565fa3714a31eeb80b

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Timestamp	Audit
August 19, 2022 2:15 pm EDT	Transfer Form Uploaded by Greg Goins - [email protected] IP 2600:1700:7b18:ec90:4cd2:772f:76f2:9197
August 19, 2022 2:16 pm EDT	TMIKY Student Forms - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
March 6, 2023 12:48 pm EDT	TMIKY Student Forms - [email protected] added by - as a CC'd Recipient Ip: 99.190.9.234
April 11, 2023 3:12 pm EDT	TMIKY Student Forms - [email protected] added by - as a CC'd Recipient Ip: 99.190.9.234
November 21, 2023 4:43 pm EDT	TMIKY Student Forms - [email protected] added by - as a CC'd Recipient Ip: 2600:1700:7b18:ec90:4cd2:772f:76f2:9197

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