Form 31 - Request For Special Reciprocal Reduction Of Fees Between Iupui And Puwl Form - Purdue University

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Graduate School Form 31
(Revised 9/15)
PURDUE UNIVERSITY
GRADUATE SCHOOL
Request for Special Reciprocal Reduction of Fees Between
Indiana University Purdue University Indianapolis (IUPUI) and
Purdue University West Lafayette (PUWL)
This form should be completed by graduate students who plan to register for courses both at Purdue University West
Lafayette (PUWL) and Indiana University Purdue University Indianapolis (IUPUI) in a given academic session or by
graduate students who hold a graduate staff appointment at one campus while registering for courses at the other campus.
(Both IUPUI graduate students who wish to enroll at PUWL, and PUWL graduate students who wish to enroll at IUPUI
may use this form.) To be eligible for this fee remission, an individual must be enrolled as a full-time graduate student at
either institution or hold a graduate staff appointment at either institution.
Please note that only general service and non-resident service fees will be covered by this reciprocity agreement for
participating graduate students. It will be the student's responsibility to make payment for all other fees assessed. For
IUPUI students enrolled at West Lafayette, examples of these fees may include repair and rehabilitation fees, technology
fees, laboratory fees, deposits, workshop fees, differential fees, and international student fees. For PUWL students enrolled
at Indianapolis, designated fees may include laboratory fees and the IUPUI general fee. Students should also note that
failure to meet registration or payment timelines at each institution may result in the assessment of late registration or late
payment fees.
Name of Student: ________________________________________
PUID No.: ___________________
Date of Birth: _______________________
IUPUI ID No.: ___________________
E-mail address: __________________________________________
Department: ____________________________________________
Home Campus:
PUWL
IUPUI
Degree Objective: ________________________________________
(Master’s, Doctorate)
Do you hold a graduate staff appointment?
Yes
No
If yes, at what campus:
PUWL
IUPUI
If yes, what type of appointment and level of CUL/FTE? ____________________________________________________
(e.g., Graduate Teaching Assistant, Graduate Research Assistant, etc. at PUWL)
(25, 50, 75, or 100 at PUWL)
Campus where course(s) will be taken:
PUWL
IUPUI
Course(s) you wish to enroll in at host campus:
Course Number: ___________ Course Name: _________________________________ Number of Credit Hours: ______
Course Number: ___________ Course Name: _________________________________ Number of Credit Hours: ______
Session to complete course(s) _________________
(Attach written approval to enroll in the course. See reverse side.)
(Fall, Spring, Summer/Year)
Other course(s) enrolled in at home campus:
Course Number: ___________ Course Name: __________________________________ Number of Credit Hours: ______
Course Number: ___________ Course Name: __________________________________ Number of Credit Hours: ______
Authorized Signatures: _______________________________________________________
_________________
Student
Date
_______________________________________________________
_________________
Major Professor
Date
_______________________________________________________
_________________
Department Head at Home Campus
Date
_______________________________________________________
_________________
Dean of the Graduate School
Date
_______________________________________________________
_________________
Bursar’s Office at Home Campus
Date
Distribute Copies to:
Bursar at Host Campus (for implementation); Departmental Graduate Office of Student (for information)

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