Transfer Course Approval Form


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

Phone: 608-796-3180     Email:


    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.



Intended date of graduation month   year

Electronic Signature and Date

     I certify the accuracy of this form.
     Name  Date