Please print this document, complete it, and return completed form to Arts and Sciences Admissions Office, 172 Goldwin Smith Hall, Ithaca, NY 14853. Approved credits earned at institutions other than Cornell count as out of college credits, i.e., not as part of the 100 credits required in Arts & Sciences courses at Cornell. Maxima: regular term, 15 credits; summer session (3-5 weeks), one credit per week plus one credit; (6 weeks or more), one credit per week plus two credits. In order to transfer credit, you must earn at least a grade of C (not C-) or above, and have an official transcript sent to the Arts and Sciences Admissions Office, 172 Goldwin Smith Hall, Ithaca, NY 14853. Criteria for granting credit (including standard for grades), vary by department.

Name ______________________________ Date ____________ Graduation Date ______________

CUID ________________  Local Email _____________________________

Local Address ______________________________________  Local Phone ______________

Advisor ___________________________ Advisor’s Dept _____________________

Name of Institution ___________________________  Duration of course ___/___/___ to ___/___/___

Course # ________________  Course Title ______________________________

Source of Transfer Credit:

[ ] Summer Session  [ ] Leave of Absence  [ ]  Mid-year Freshmen  [ ] HS Campus  [ ] College Campus

[ ] Other (explain) __________________________________________________________________

HS Graduation Date ________________ Does this credit count toward HS graduation?  [ ] Yes  [ ] No

The above credit should be applied toward:

[ ] Major _______________________________ Equivalent Cornell Course, if any ________________
              Major Advisor’s Approval

Department Approval ___________________________________ Date ____________