Transfer Credit Appeal Form
Date: ___________________________ Banner ID: ____________________________________
Student Name: ________________________________________________________________________
Buffalo State Email Address: _____________________________________________________________
Transfer course you are appealing:
Transfer Institution: ______________________________________________________________
Course Title: ____________________________________________________________________
Course prefix & number: __________________________________________________________
Along with this form, please attach a catalog description of the course and/or a copy of the syllabus for the
course you are wishing to transfer. You may also submit a letter outlining the reasons for the appeal, including
how and why the course should transfer.
Submit materials to the academic department chair for the transfer course in question.
DEPARTMENT CHAIR MUST SIGN AND DATE THIS FORM
(Date received constitutes the beginning of the 10-day notification process)
Department: ___________________________________ Date received: ____________________
Signature of Chair or designee: ___________________________________________________________
ACCEPTED* as equivalent to Buffalo State course: _____________________________________
Effective: Spring Fall 20___ For this student only OR For all students
DENIED
Signature of Chair or designee: ____________________________ Date of Decision: ___________
*Approval by the chair is subject to verification by Admissions that the course is eligible for acceptance at SUNY
Buffalo State.
Once a decision has been made, please return to Moot Hall 110 or scan and email to transfer@buffalostate.edu
.
FOR OFFICE USE ONLY:
Date entered: ________________________ Initials: ______________ CEEB Code: __________________
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