Request to Pursue Courses at
Another Institution
Form
____________________________________________________
___________-___________-___________
Last Name
SSN
First Name
M.I.
_____________________________________________________________________
Major
______________________________________________
Degree
_____________________________________________________________________
Anticipated Graduation Date
_____________________________________________
Accumulated Number of Credits
_____________________________________________________________________
Home Campus
_____________________________________________
Current G.P.A
Reason for the request to pursue courses at another institution that will be used to satisfy graduation requirements for my degree at
Strayer University:
__________ Course not offered and I am graduating next quarter.
__________ I will be residing near this institution during the upcoming quarter and wish to accelerate my
studies.
__________ Other (Please provide details):______________________________________________________________
Name and Location of Institution to be Attended: _______________________________________________________
__________________________________________________________________________________________________
Other Institution
Course Name and Number
Corresponding Strayer University
Course Name and Number
1. __________________________________________
1. ____________________________________
2. __________________________________________
2. ____________________________________
3. __________________________________________
3. ____________________________________
4. __________________________________________
4. ____________________________________
Note: A copy of the course description, semester/quarter hours of credit, dates of the course, and a catalog (if possible) are to be
submitted for each course being requested.
How many additional credits will you be taking at Strayer University while enrolled in the courses listed above? _______
Student realizes that Strayer University requires minimum grades of “C” for undergraduate courses in transfer and “B” for graduate
courses in transfer, and receipt of official transcripts before credit is recorded. Only credit earned at Strayer University is counted
toward residency.
By signing below, the student agrees to all University policies regarding minimum grade requirements for transfer credit, residency
requirements, and maximum course load restrictions, as outlined here and in the Strayer University catalog.
Student Signature _________________________________________________
Date _______________________________
__________ Approved by the Campus Dean
Date ________________________________
__________ Disapproved by the Campus Dean
Date ________________________________
Reason ______________________________________________________________________________________________________
Campus Dean Signature ________________________________________
Date ___________________________
(Original to student with a copy to the student’s file)
SU 0113-0998
Last updated 9/02