Interinstitutional Approval Form
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Interinstitutional Approval Form
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(FOR STUDENTS TAKING COURSES ON ANOTHER CAMPUS)
Home Institution:
Host Institution:
Duke University
UNC - Chapel Hill
Duke University
UNC - Chapel Hill
NC Central University
UNC - Charlotte
NC Central University
UNC - Charlotte
NC State University
UNC - Greensboro
NC State University
UNC - Greensboro
Classification:
Graduate / Professional
Undergraduate
Department / College: ____________________________
Middle name or initial
Student ID number
Last name
First name
CURRENT LOCAL ADDRESS
Street address, RFD, or PO Box number
Apartment
Telephone
City
State
Zip
Email address
PERMANENT MAILING ADDRESS (where you will be receiving registration materials)
Street address, RFD, or PO Box number
City
State
Zip
County
Country (if not US resident)
What is your legal residence?
County________________
State_________
Country__________________________
CITIZENSHIP:
US Citizen
Nonresident alien
Resident alien
DATE OF BIRTH (xx/xx/xxxx) :__________________
PLACE OF BIRTH:______________________________________________
SEX:
Male
Female
APPLICANT'S ETHNIC GROUP: Ethnic identification is required by the Office of Civil Rights of the Department of Health Education and
Welfare to assure compliance with the Civil Rights Act. Ethnic origin is not a factor in admission; all applications are considered without
reference to sex, creed, or race.
African-American (not of Hispanic origin)
American Indian or Alaskan Native
Asian or Pacific Islander
Hispanic
White (not of Hispanic origin)
Other / Foreign
Have you ever attended the visited institution:
No
Yes
If "Yes," last term attended _________________________
T
Are you graduating this term?
Yes
No
erm you desire to attend: Fall_____ Spring_____ Summer I_____ Summer II_____
Year
Year
Year
Year
Number of hours for which you will be enrolled for the above semester: Home institution_________
Host institution_________
COURSE(S) TO BE TAKEN ON VISITED CAMPUS
(please consult the visited institution's schedule of classes to correctly fill out
NOTE:
this section):
Courses cannot be taken on a pass/fail or audit basis.
Hour/Days
Section
Cr. Hrs.
Host Instructor Approval (if
Subject Abbr.
Course No.
Title
required) or attach documentation
By signing and dating this form, I consent to the sharing of all my educational
records (FERPA -protected information) among the home and host institutions.
Date
Approval of Dept/Academic Advisor
I also agree to abide by the student code of conduct at the host institution.
Date
Approval of College Dean
Approval of Home Institution Registrar
Student's signature
Date
Date
Registration Office - Host Institution Use Only
Registration Office - Home Institution Use Only
Visiting student registered on __________________________
Sent completed interinstitutional form to visited institution by:
Visiting student not registered because___________________
__________________________________________________
US Mail / State courier
Fax
Student
Date ____________
Sent confirmation / rejection notice by:
Student dropped course -
US Mail
Email
Student
Date_______________
Visited institution notified (date) _____________________________
Received drop notice_________________________________
*Return signed form to the Registrar's office of your home institution
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