Warning: This form will not be sent on a secure network. If you prefer, you may print the form to fill it out and then mail it to the campus contact on the campus to which you wish to transfer:

Full Legal Name:
First:         Middle: Last:

Email Address:
Your Ten Digit University Identification Number:     

List all addresses where you have resided in the past twelve months.

Home Address:

Street Address:

City: State:
Zip:         Phone:
County:


Home Address 2:
Street Address:

City: State:
Zip:         Phone:
County:


Home Address 3:
Street Address:

City: State:
Zip:         Phone:
County:

On-Campus Address (if applicable):
Street Address:

City: State:
Zip:         Phone:
County:

Semester to Transfer:
Year: January (Spring) May (Summer I) June (Summer II) August (Fall)

Transfer From:
Bloomington Columbus East Fort Wayne Indianapolis
Kokomo Northwest South Bend Southeast

School or Division Last Enrolled:
Major:
Approximate Number of Completed Credit Hours:

Transfer To:
Columbus East Kokomo Northwest South Bend Southeast

School or Division Desired:
Intended Major:

Transfer is: Permanent Visiting


Class Standing: Freshman Sophomore Junior Senior
Currently Enrolled Yes No
Estimated Hours Enrolled: hours

Have you attended any other college or university since you last attended an IU campus?
 
Yes No

If yes, then please list those schools and the dates attended:

If you attended another college or university since you last attended an IU campus you will need to have a transcript sent to your desired IU campus for evaluation of possible transfer credit. A sample transcript request form is available.


Note: Submission of this form does not assure acceptance of student by receiving school.

   

Indiana University -- Quality Education.  Lifetime 
Opportunities.

Last updated: Last updated: 3 July 2002
Comments: IUPUI Registrar
Copyright 2002, The Trustees of Indiana University