Jackson State University
Graduate School REQUEST FOR PROGRAM TRANSFER
1. To transfer from one major department to another during a term in which a student is registered, the
student is required to submit a new application.
2. To transfer from one program to another program located in the same department, the student is
required to submit a “Request for Program Transfer” form and submit it to the current major department,
requesting transfer. If the department approves, the approval is noted, a current transcript is attached to
the form, and forwarded to the school Dean. The school Dean indicates his/her decision, and forwards it
to the Dean of the Graduate School for final action.
Name: _________________________________________________________ Student J#:____________________
Last First M.I.
Address: ______________________________________________________________________________________
Street City State Zip Code
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Complete by Student:
I hereby request that I be transferred from: __________________________________________________________
Current Department Degree Program
To ___________________________________________________________________________________________
Prospective Program Signature Date
This request is made for the following reason (s): ______________________________________________________
______________________________________________________________________________________
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Complete by Department:
This student is/is not in good academic standing in: ____________________________________________________
Department Degree Program
__________________________________________________ ________________________________________
Present Advisor Date Present Department Chair Date
Comments: ____________________________________________________________________________________
_______________________________________________
School Dean and Date
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Complete by the Graduate School:
GECE: Yes _______ No ______ ENG 500 _______ Approve ______ Disapprove ________
Comments: ____________________________________________________________________________________
_________________________________________________________
Dean of Graduate School Date
