Transfer Course Approval Form

Registrar's Office: Viterbo University; 900 Viterbo Drive; La Crosse WI 54601
Phone: 608-796-3180     Email:

    Submit this form prior to enrollment in the course at the college/university listed below.

  First name   Middle name     Last name   
  Email     Class      Major 
  Student ID number    Advisor   
1.       I plan to take the following course(s) at the named college/university: 
a.     School  
     Dept     Course no     CourseTitle   Sem hrs(credits)  
b.     School 
     Dept      Course no      CourseTitle  Sem hrs(credits)  
  c.     School
    Dept      Course no      CourseTitle  Sem hrs(credits)  

2.      I plan to take this during the    on the following dates    in the year of   .


3.      I would like these courses to transfer to Viterbo as:

   a.   Dept     Course no     CourseTitle   Sem hrs(credits)   For Core Requirement?    
  b.    Dept      Course no      CourseTitle   Sem hrs(credits)   For Core Requirement?    
  c.    Dept      Course no      CourseTitle   Sem hrs(credits)   For Core Requirement?    
All students must take as a minimum the last 30 consecutive hours from Viterbo.  This course(s) should not be part of the last required semester hours earned from Viterbo to be applied to your degree.  On a rare occasion a course may be accepted for transfer within these hour limitations with permission from the Vice President for Academic Affairs on the Academic Policy Exception Form.

Please see the transfer credit policy section of the current catalog for further information on transferring credit.  Certain limitations apply to the total number of hours, number of hours from certain disciplines and type of credit accepted.

4.   Intended date of graduation month     year

Electronic Signature and Date

     I certify the accuracy of this form.
       Name     Date