Revised, 6/2013
Request for Dual Degree Non-Law Credits to be
Applied to School of Law Transcript
Please complete all information and submit to Law School Registrar.
Name: Banner ID: Dual Degree Program:
J.D./M.B.A. Students:
I request the following courses be transferred to my Law transcript (9 credits):
Data and Decisions; MBA-642 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
The Organization; MBA-643 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Integrated Consulting Module; MBA-653 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
J.D./M.H.A. Students:
I request the following courses be transferred to my Law transcript (9 credits); choose three:
Health Care Organizations; HMP-500 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Management of Human Resources; HMP-538 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Management of Health Care Organizations; HMP-530 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
J.D./M.P.H. Students:
I request the following courses be transferred to my Law transcript (9 credits); choose three:
Health Care Organizations; HMP-500 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Health Policy; HMP-550 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Principles of Biostatistics; BST-500 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
J.D./M.S. Students:
I request the following courses be transferred to my Law transcript (9 credits); choose three:
Evaluation Sciences; ORES-541 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Pharmacoeconomics; ORES-540 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Clinical Trials; ORES-542 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
Comparative Effectiveness Research; ORES-544 (3 credits):
Instructor: _______________; Semester:___________________; Grade:____________
All Other Dual Degree Students:
I request the following courses be transferred to my Law transcript (9 credits):
Course: _____________________________; Instructor: ______________ ; Semester: ____________ ; Grade: _________
Course: _____________________________; Instructor: ______________ ; Semester: ____________ ; Grade: _________
Course: _____________________________; Instructor: ______________ ; Semester: ____________ ; Grade: _________
Student Signature: __________________________________________________________ Date: ________________
Assistant Director, Center for Health Law Studies: _________________________________ Date: ________________
(J.D./M.H.A. or J.D./M.P.H. students only)
Dean of Students: ____________________________________________________________ Date: ________________
Select One