Please print this form and the Graduate Non-Degree Agreement and complete the necessary information. Mail both forms to the address listed at the bottom of this page.
Facsimiles are acceptable.
Only a limited number of credits earned prior to being fully admitted to the degree program may be used toward fulfilling degree requirements. I certify that none of the information on this form is false or has been withheld. I further certify that I understand that giving false information or withholding information may make me ineligible for admission or to continue my enrollment at the University of Memphis. The University of Memphis, a Tennessee Board of Regents Institution, offers equal educational opportunity to all persons without regard to race, religion, sex, creed, color, national origin or disability. The University does not discriminate on these bases in recruitment and admission of students or in the operation of any of its programs and activities,as specified by federal laws and regulations.