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

Have you been convicted of a felony or misdemeanor, have a charge currently pending, been subject to formal disciplinary action at any college or university, or have you engaged in behavior that resulted in injury to person(s) or personal property? (If you answer YES, go to http://enroll.iupui.edu/admissions/undergraduate/freshmen/disclosure.html info for more information on felony conviction policy and use of this information.)
Yes No

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