www.indwes.edu Phone: 765-677-6507
THIS SECTION OF THE FORM TO BE COMPLETED BY THE STUDENT.
A student desiring to transfer cannot be accepted for admission without this form.
___________________________________________ ___________________________________________
Last Name First Name
___________________________________________ ___________________________________________
Institution/College Transferring From Dates of Attendance (Month/Year to Month/Year)
___________________________________________
Social Security Number
I hereby grant permission to the appropriate college/university official to respond candidly to the questions asked on this form.
___________________________________________ ____________________________
Student Signature Date
Student, please indicate the following:
_____ I hereby waive my rights to request access to this form upon its completion.
_____ I do not waive my rights to request access to this form upon its completion.
1. Has this student ever been under academic probation or social discipline while attending your institution? ____ Yes ____ No
If yes, please give a brief statement of the nature of the offense, probation, and disciplines.
2. Would this student be permitted to return to your college at the next enrollment period? ______ Yes ______ No
If no, please indicate the reason:
3. Any further comments (use additional paper if necessary).
_________________________________________ _________________________________________ _____________________
Name of School Official Institution Date
_______________________________ ________________________________________ ____________________________
Title/Position Email Phone Number
INDIANA WESLEYAN UNIVERSITY
TRANSFER INFORMATION FORM
The SCHOOL should return this form to:
Admissions Office, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN 46953-4974
Fax: 1-765-677-2333 Email: transfers@indwes.edu
