IUPUI Temporary Intercampus Transfer

Please select one of the following:

New application for an upcoming term
Making changes to a previously submitted application (major, starting date/term, address, name changes only)

Student Information:
First:         Middle:         Last:

Previous Names used on other IU Campuses
Other First:         Other Middle:         Other Last:

Email Address:
*Birthdate (required): MM/DD/YYYY
Your Ten Digit University Identification Number:     
* This information is being used only to locate your information in the IU system

Home Address:
Street Address:
City: State: Zip:         Phone:

For Indiana Residents:
On-Campus Address (if applicable):
Street Address:

City: State: Zip:         Phone:

Semester of Transfer:

Campus Transfer FROM:
Bloomington Columbus East Fort Wayne Kokomo Northwest South Bend Southeast

Indiana University-Purdue University Indianapolis is committed to maintaining a safe environment for all members of the university community. As part of this commitment, IUPUI requires applicants to disclose this information as a mandatory step in the application process

1) Have you been subject to formal disciplinary action (including, for example, but not limited to, suspension or expulsion) for academic or nonacademic reasons at any high school, postsecondary institution, college, or university?
Yes No

2) Have you ever been charged or convicted of a crime (or a foreign legal equivalent) that has not been expunged by a court?
Yes No

3) Do you have any currently pending criminal charges (or a foreign legal equivalent) against you?
Yes No

4) Have you engaged in any behavior that caused injury to any person(s) or property (including, for example, but not limited to, vandalism or behavior that led to a restraining order against you) which resulted in some form of discipline or intervention?
Yes No

If you answered YES to any of the 4 questions above, go to http://enroll.iupui.edu/admissions/undergraduate/freshmen/disclosure.html for more information on felony/disciplinary policy and use of this information.

By action of submitting this application, I acknowledge the following:

I understand that withholding pertinent information requested on this application or giving false information will make me ineligible for admission to IUPUI or subject to cancellation of admission if admission has already been granted or dismissal if already enrolled.

I certify that all statements on this application are complete and correct, including the list of all schools attended.

If necessary I will send a letter describing criminal or disciplinary history as described at the following website at Criminal Activity Disclosure Policy. The letter will be sent by certified mail and I will keep the receipt certifying it was received by IUPUI.  The letter contains a statement granting my permission to officials at all institutions and agencies involved to release information needed by IUPUI to substantiate statements I have made in my letter.  If you are applying close to the deadline date it may not be possible for your application to be processed prior to the start of the academic semester.


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Comments: IUPUI Registrar
Copyright 2002, The Trustees of Indiana University