Rev. 08.29.12
FM 039
PETITION TO TRANSFER COURSES
Name: _______________________________________________________________ Z#: _______________________
CPO Box: _________________ Phone #: ____________________ ORU Email: _______________________________
Address: ___________________________________ City: ____________________ State:____ Zip: ______________
Name of Transfer Institution: _________________________________________________________________________
City, State: ________________________________________________________________________________________
Accreditation of Transfer Institution: ___________________________________________________________________
Title of Transfer Course: _____________________________________________________________________________
Date you first enrolled at ORU: _______________________________________________________________________
When WAS or when WILL transfer course be taken? ______________________________________________________
Requesting credit for the following ORU course: _________________________________________________________
Class: freshman sophomore junior senior grad student Major: ________________________
Course Information: Please attach a syllabus or course description from the university’s catalog indicating additional
information such as type and frequency of assignments, papers and tests, the number of study hours required per week,
the number of class hours, textbooks and their authors, etc.
Student's signature: Date:
FOR OFFICE USE ONLY
The Registrar’s Office has reviewed this request and determined that additional approval must be obtained from the
respective academic department.
_______________________________________________________________________
Signature Date
I accept the above course for elective credit only. A grade of "C" or better must be earned in the course.
I accept the above course as fulfilling an ORU requirement as stated below. A grade of "C" or better must be
earned in the course:
Subject Course # ORU course title
Chair of Department in which course is offered Date
Degree-Granting Dean (College of Nursing students only) Date
Note: All students are required to complete their last 30 hours at ORU.
White copy: Registrar’s Office ♦ Yellow copy: Department of course ♦ Pink copy: Student
