D2D Release Form Request

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Congratulations on your acceptance into the Destination to a Dream (D2D) Program!
If you are considering participating in D2D for the fall semester, please complete the questions below so we may send you a records release document. By signing the Records Release Form and sending it back to the Admissions Office, you are giving Fredonia permission to share your personal contact information and your high school transcript with Jamestown Community College (JCC). JCC will then use this information to help you complete their application and complete next steps to be enrolled. If you have any questions, please contact the office of New Student and Transition Programs at 716-673-4969 or email Madeline.Burns@fredonia.edu.

First Name *

Last Name

Street *

City *

State *

Zip *

Email Address *

Cell Phone Number

May we text you?

Yes

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I understand that by requesting the Records Release Form be sent to me, that I am indicating my interest in participating in the D2D program between Fredonia and JCC. This form does not require me to participate, but it does allow me to move forward with the next steps towards enrollment. *

Yes

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