Today’s Date _____________________________
Name_________________________________ ID#_________________ Year of Graduation ____________
Cell #_____________________ Home #_____________________ Campus Box # ________________
Major(s):____________________________________ Minor(s): ____________________________________
Period of Study Abroad: Fall 20_____ Spring 20_____ Winter 20_____ Summer 20_____
Name of Partner Program: _________________________________________________________________
Name of University or Program Title: _________________________________________________________
Study Abroad City and Country:______________________________________________________________
A. Courses in your Major(s) or Minor(s) Chair of Department
Number Name Will Transfer As… Initials Credits
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
B. Core Courses/General Education Requirements Registrar’s Office
Number Name Will Transfer As… Initials Credits
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
C. General Elective Courses Registrar’s Office
Number Name Initials Credits
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
APPROVED BY_________________________________ ENDORSED BY _______________________________
Major Advisor Department Chair (*Advisor for BU/AC Majors)
____________________________________ __________________________________
2
nd
Major Advisor 2
nd
Major Chair
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