Viterbo University - The University of Opportunity: Hope and Help

Transfer Course Approval Form

^{Registrar's Office: Viterbo University; 900 Viterbo Drive; La Crosse WI 54601}

^{Phone: 608-796-3180 Email: registrar@viterbo.edu}

Submit this form prior to enrollment in the course at the college/university listed below.

First name	Middle name	Last name
Viterbo Email	Class	Major
Student ID number	Advisor

1. I plan to take the following course(s) at the named college/university:

a.	School
	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs

b.	School
	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs

c.	School
	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs

2. I plan to take this during the on the following dates in the year of .

3. I would like these courses to transfer to Viterbo as:
a.	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs
b.	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs
c.	Dept Course no CourseTitle Sem hrs(credits) OR Qtr hrs

All students must take as a minimum the last 30 consecutive hours from Viterbo. This course(s) should not be part of the last required semester hours earned from Viterbo to be applied to your degree. On a rare occasion a course may be accepted for transfer within these hour limitations with permission from the Vice President for Academic Affairs on the Academic Policy Exception Form. Please see the transfer credit policy section of the current catalog for further information on transferring credit. Certain limitations apply to the total number of hours, number of hours from certain disciplines and type of credit accepted.

4.	Intended date of graduation month year

Electronic Signature and Date
I certify the accuracy of this form.
Name Date