Transfer Report

This form should be completed by a college/university official who has access to and is authorized to release information pertaining to the student's academic and disciplinary records. Please complete the following information for the student applying to Lynn University.

Student Information

First Name

Last Name

Birthdate

Email Address

Most Recent College or University Attended
Start typing the name and/or location of your institution and a list of choices will appear. Select your institution. If your school/college/university is not listed, you can type it in.

**HIDDEN** CEEB Code

College/University Details

College/University Name

Name of College/University Official

Title

Email

Phone Number

College Standing Information

Is the student eligible to return to your institution? If no, please explain briefly.

Yes

No

Return eligibility explanation

Has the student been the subject of any disciplinary action for conduct at your institution either on or off campus? If yes, please explain briefly.

Yes

No

Disciplinary action explanation

Has the student been suspended, dismissed, expelled or forced to withdraw from your institution for disciplinary reasons? If yes, please explain briefly.

Yes

No

Suspension or dismissal explanation

Are there any further comments you wish to provide?

I affirm the information provided above and I understand falsification of information provided in this document may impact the student's admission and/or enrollment status at Lynn University.

Yes

To affirm this information, please contact me by:

Email

Phone

Date

Electronic Signature