===== PAGE 1 ===== # KENTUCKY STATE UNIVERSITY OFFICE OF THE REGISTRAR PHONE: 502-597-6340 FAX: 502-597-6239 ## STUDENT VISITING ANOTHER INSTITUTION FORM (22-16) This form permits a Kentucky State University student to attend another institution as a visiting student. By completing this form, all parties agree to accept the course in transfer. To successfully transfer the course to Kentucky State University, the student must pass the course with a grade of "C" or better. An official transcript of the course must be sent from the visiting institution to Kentucky State University, Transfer Center Coordinator, ASB Suite 323, East Main Street, Frankfort, KY 40601. This form must be completed and the course approved prior to the student enrolling at the other institution. This form is null and void if students' academic standing changes at the end of term. Only courses listed below will be accepted. Student Name: ___ Social Security Number: ___ Session/Term to attend other Institution:_____ Year:_____ Major:_____ Visiting Institution: ___ Address of Institution (required) ___ COURSE(S) TO BE TAKEN

COURSE NUMBER	COURSE TITLE	CREDIT HOURS	UNDERGRAD/ GRADUATE	KSU EQUIV. COURSE

Student Signature: ___ Date: ___ Advisor Signature:___ Date:___ Chairperson/Dean Signature: ___ (*Undeclared - Director of Academic Advising) Date:___ Registrar's Office: _____ Date: _____ (Required for Official Approval) This document is not official without the University Raised Seal. ## FOR OFFICE USE ONLY Good Standing: □ Yes □ No Seal Effective Date:___ Classification:___ GPA: ___ Current Enrollment Status: ☐ Full Time □ Part Time Date Sent:___