APPLICATION FOR CHANGE OF COLLEGE AFFILIATION
OFFICE OF THE HEADS OF COLLEGE

Requests for change of college affiliation will be referred to the Special Committee on Transfers.  Prior to submitting this form, students must meet with and have this form signed by the Head and Dean of both the sending and receiving colleges and by all prospective roommates.  The completed form must be submitted to the sending college dean’s office by Friday, February 9, 2018.  Use the back of this form to state briefly your reasons for requesting a transfer.  Please note that submission of this form with the required signatures does not assure that your request will be approved.  You will be notified of the committee’s decision by your head or your dean.

NAME                                                               CLASS                                      DATE            

ADDRESS                                                         SID#_                                       PHONE           

I request a change of college affiliation from 						              College to  

  College.   Signature:

I expect to live off campus.

I expect to live on campus and, if my transfer request is granted, I will room in a suite with the students from the receiving college who have signed below.  By signing, they (1) commit to room with me next year, (2) recognize that these arrangements cannot be canceled in order to form other rooming groups or to room in singles, and (3) realize that our rooming group must conform with the rooming regulations for our class in their college.

Name:							Signature:

Name:							Signature:

Name:							Signature:

Name:							Signature:

Signed: 						    Signed: 

                      Sending College Head of College                                             Sending College Dean

Approved by the Special Committee on Transfers:

Signed:						    Signed:

                    Receiving College Head                                            Receiving College Dean

		

USE THE BACK OF THIS FORM TO STATE BRIEFLY YOUR REASONS FOR REQUESTING A TRANSFER.