Graduate Admissions
FedEx Inst. of Technology Bldg, Suite 201
The University of Memphis
Memphis, TN 38152
Phone: (901) 678-3685
Fax: (901) 678-0378
GRADUATE ADMISSIONS
CHANGE OF STATUS APPLICATION
This form should be completed ONLY if you are a currently enrolled degree-seeking graduate student. Complete
all information, print form and mail to address listed below. Facsimiles are acceptable. Return to Graduate Admissions
when completed.
Note: All Fields are required.
*Ful
l Legal Name: ____________________________________________________________________________
*Banne
r U-Number: _______________________
*Date
of Birth: _______________________
*Current Address: ___________________________________________________________________________
*City,
State, Zip: ___________________________________________________________________________
*Tel
ephone Number: ______________________ *Email Address: ____________________________________
*Pref
erred Term of Admission: ______________________________
DEGREE
SEEKING APPLICANTS
*Please indicate the degree program for which you are applying:
*Degree:
*Majo
r:
*Conce
ntration, if applicable:
*Test
Data: Please indicate which of the following admissions test you have taken or plan to take:
GRE
General: Date: ________________ GMAT: Date: ________________
PRAXIS: Date: ________________ MAT: Date: ________________
*Current
ly enrolled in the following major:
*Degr
ee:
*Majo
r:
*Wil
l you be completing your current degree program: Yes No If yes, when? ____________________
Signature: _____________________________________________________ Date: ______________________
Revised: 11/05/2013
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