EASTERN MICHIGAN UNIVERSITY
Graduate School
REQUEST FOR TRANSFER OF CREDIT

Please complete ALL information requested. Please PRINT clearly.

Student Name ___________________________________________
 Student Number ________________________
Last, First, Middle
  
Address ________________________________________________________________________________________
Phone (_____)
area code
___________________________
work number
Phone (_____)
area code
 _______________________
home number
I would like to request that the following course be transferred to my Eastern Michigan University graduate program.
Course No. Course Title
 # of credits/ grade received List date when course was taken Name of college/ university where course was taken Transcript on file?
YES or NO
 If NO, list the date when the transcript was requested
             
             
             
I understand that only courses with a grade of “B” (e.g., B+, B) or better may be transferred and that only the credit hours (without the grades) will appear on my Eastern Michigan University transcript, should the transfer be approved. Courses with grades of P (Pass), CR (Credit) or S (Satisfactory) will not transfer. I have read the section on “Transfer of Credits to Degree Programs” in the Graduate Catalog and understand and will abide by all of the requirements, including the six-year time limitation. I further understand that transfer credit approved will appear on my transcript or academic record, even if it is not ultimately used on my program of study. The transcript from the college/university where this course was originally taken is currently on file, or has been requested.
________________________________________________________
Student Signature		 _____________________________
Date

This section to be completed by the Graduate Adviser.

Request for Transfer of Credit has been recommended pending the receipt of the official transcript. A copy of the Program of Study, showing where the transfer course(s) will be used, is attached.

Print Name: ________________________________ Department of: ______________________________
_________________________________________
Graduate Adviser Signature		 _______________________
Phone Number		 ________________
Date
This section to be completed by the Graduate School once official transcript is received:
Request is: [ ] Approved [ ] Denied _______________________________________
Signature		 ________________
Date
Number of credits transferred: ________________
The Graduate Adviser should forward this form to Graduate School, Starkweather Hall, Ypsilanti, MI 48197. Fax: 734.487.0050