Fillable Transfer Request/Exemption Form (The Michener Institute of Education at UHN)

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Transfer Request/Exemption Form (The Michener Institute of Education at UHN)

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Transfer Request/Exemption Form
Registrar’s Office
222 St. Patrick Street Toronto, ON M5T 1V4
regoffice@michener.ca │ 1 (416) 596-3117 or 1 (800) 387-9066
TransferExemptionRequestForm 1 29-Oct-19
Date Received
Office Use Only
Transfer/exemption requests will only be considered for admitted applicants or current full-time students. Must be received 3 weeks prior to the start of classes.
STUDENT ID: ______________________
DATE OF BIRTH:
MM
DD
YYYY
NAME AND ADDRESS (Please Print Clearly)
LAST NAME
FIRST NAME
MIDDLE NAME
TELEPHONE (Home)
TELEPHONE (Mobile)
EMAIL ADDRESS
REQUEST FOR CREDIT TRANSFER/EXEMPTION
External Institution
External Course(s)
Course Title(s
Credit Requested
OMAS Grade*
(Office Use Only)
Credit Granted
Minimum grade of C or 2.00 Grade Point on OMSAS Scale
Please include supporting documents with your application.
Official Transcripts
Detailed course description(s)/
outline(s)
WES/ICAS equivalency documents (if
applicable)
Date: ______________ Student’s Signature _______________________________________________
PAYMENT INFORMATION
Fee $25.00. Please indicate payment method:
Visa
AMEX
MasterCard
Cardholder Signature
Cardholder Name (Please Print)
Date
Other Payment Methods:
Cash(in person
only)
Debit Card (in person only)
Money Order
Certified Cheque or Money Order
EXPIRY DATE
OFFICE USE
ONLY
Evaluator: ___________________________ _____________________________________ _________________
Name Signature Date
Chair: ___________________________ _____________________________________ _________________
Name Signature Date
Registrar’s Office: ________________________________ ___________________________________
Entered By Date
The information on this form is collected under the authority of the Michener Institute of Education at UHN and will be protected and used in compliance with the Ontario
Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31. Student information held by the Michener Institute of Education at UHN may be used for
administrative and statistical purposes of the Institute and/or the ministries and agencies of the Government of Ontario and the Government of Canada.
(Office Use Only)
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Transfer RequestExemption Form (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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