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:
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

Behavioral Disclosure
We are committed to maintaining a safe learning environment. As part of that commitment, Indiana University requires applicants to disclose if they

  • have been subject to formal disciplinary action (including for example, but not limited to, suspension or expulsion for academic or non-academic reasons at any high school, post-secondary institution, college or university;
  • have been charged with or convicted of a crime (or a foreign legal equivalent) that has not been expunged by a court;
  • and/or have engaged in behavior that caused injury to person(s) or personal 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.

A previous disciplinary action, charge, conviction, or conduct of the sort identified here does not automatically disqualify applicants from admission to IU, but they do require review by the campus admissions committee.
PLEASE NOTE: By submitting your application to Indiana University, you acknowledge and agree that you have a continuing obligation to inform the University of any formal disciplinary action

  • for academic or non-academic reasons at any educational institution;
  • any legal charges and/or convictions (or foreign legal equivalents) that have not been expunged by a court;
  • and/or any behavior that causes injury to person(s) or property which results in some form of discipline or intervention that occurs from now until your enrollment at IU.

You must provide updated information to the campus admissions committee prior to class registration or class attendance, whichever is applicable. At that time, the campus admissions committee will review the information provided and may consider whether to delay or rescind your admission to IU.

Behavioral/Disciplinary Disclosure

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

2) Have you ever been charged with 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

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.

   

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Opportunities.

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