Office of Admissions Bucknell University Lewisburg, Pennsylvania 17837 Phone (570) 577-1101

Recommendation for Transfer Admission (Form C)

This section to be completed by the applicant.                             Date ___________________________________

Mr.     Mrs.
Miss    Ms. ____________________________________________________________________________________

Name of student

Home address

           This authorizes (institution attended) _____________________________ to release to Bucknell University the information requested below.
 
Dates of attendance __________________________________________
 
Social Security number ______________________  Signature of student _____________________________________
Please submit to the Dean of Students for completion

---

To the Dean of Students:

The student named above is applying to Bucknell University as a transfer student.  We will be grateful for your cooperation in providing us with the confidential information listed below.
 
Is the student eligible to continue at your institution?

______ 1) yes

______ 2) yes, conditionally

______ 3) No

If 2 or 3, please explain.

 
Has the student been the subject of formal disciplinary action?

______ 1) yes

______ 2) No

If yes, please explain

 
Does the student have any physical, mental, or emotional problems which should be brought to our attention?

______ 1) yes

______ 2) No

If yes, please explain

 
Are there any special situations in the student's background that should be considered?
 
Additional comments/recommendations.

 

Information based on:	______ records and reports only	______ casual contacts
	______ personal acquaintance	______ counseling contacts

 
Thank you and please return as soon as possible to to:
Coordinator of Transfer
   Student Admissions
Office of Admissions
Bucknell University
Lewisburg, Pennsylvania 17837

Name: ______________________________________ Signature: ____________________________________ Title: ________________________________________ College: _____________________________________ Date: _______________________________________