Updated 5.25.16 bc
Student Name: _________________________________________ T#: __________________ Term: _________
(Last) (First) (MI)
Major: __________________________________ Class: _______________ Graduation Date: _____________
Course(s) to be taken by extension or in-residence at: ________________________________________________
(Name of Institution)
This form should be filed by any student desiring to enroll for extension work or in-residence work at another
institution with the intention of transferring the credit to Tennessee Tech. Official transcripts of such study should be
furnished immediately upon completion of work. See the Catalog and Student Handbook for residence requirements for
graduation and for regulations concerning courses. Submit this form to the Records Office after you have obtained the
necessary signatures below.
TRANSFER WORK WILL BE AWARDED IF FROM A REGIONALLY ACCREDITED INSTITUTION.
No. & Title of TTU equivalent
course
Cr. Load at
TTU during
this period
I understand that approval of this request is effective only for the period indicated above.
Student Signature: ___________________________________________ Date: ___________________
Approval Signatures:
Advisor: _________________________________________________________ Date: ___________________
Chairperson of the Department in
which the work is offered on campus: ____________________________________ Date: ___________________
Dean of School or College in which enrolled: ______________________________ Date: ___________________
Dean of College of Education
(If working toward teacher certification): _________________________________ Date: ___________________
Request to Study at Another Institution
