OFFICE OF THE REGISTRAR

Waterloo, Ontario, Canada N2L 3G1

519-888-4567, ext. 35378 | fax 519-746-2882 | uwaterloo.ca/registrar/

Plan Modification Application

for Internal Transfer Form

Instructions
1. Print in block capital letters.
2. Sign and date the form below.
3. Attach a rsum of your work experience if you are applying for a Co-op Plan and were not previously registered in Co-op.
4. Make a copy for your records, and submit the original Plan Modification/Application for Internal Transfer Form and rsum (if applicable) to the
Office of the Registrar.
Note: Normal processing time is 2 weeks, but may be subject to a review of your most recent academic performance.
Please select one as appropriate:

Plan Modification

Application for Internal Transfer, e.g., Faculty transfers (complete pages 1 and 2)

Waterloo student identification number ________________________________________

Last name ______________________________ First name ______________________________ Middle name(s) _____________________________
Street address ______________________________________________________________________________ City ___________________________
Province _____________________________ Postal code ________________ Email address ______________________________________________
Home phone (area code) _________ (number) _____________________ Business phone (area code) _________ (number) _____________________
Requested academic information include all majors, minors, options, and specializations under current and requested academic plans.
Current academic plan ______________________________________________________________________________________________________
Academic program
Form of study
Campus

Honours
Regular
UW

4-Year General
3-Year General
Co-op
Online
STJ
REN

Non-degree/Post-degree

Exchange

Requested academic plan ____________________________________________________________________________________________________

Academic program
Form of study
Campus
Start term

Honours
Regular
UW
Fall

4-Year General
3-Year General
Non-degree/Post-degree
Co-op
Online
STJ
REN
Winter
Spring
Year ________

Exchange

Reason for Request indicate your academic interests in the requested plan and explain the reasons for changing your plan. Attach additional pages as necessary.
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Student signature _______________________________________________________ Date ______________________________________________
Plan Modification Approvals See page 2 for internal transfer approvals.

Reset

Only where changes are required, indicate the Undergraduate Calendar regulations to be followed for the requested plan modification above.

Admit

Refuse

Academic program type calendar year (e.g., 2010-2011) __________________ Academic plan calendar year (e.g., 2010-2011) ___________________
Options/minors calendar year (e.g., 2010-2011) __________________
Comments ________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Department approval name ________________________ Signature ________________________ Extension number ________ Date ______________
Co-operative Education and Career Action
Approval (if applicable) ____________________________ Signature ________________________ Extension number ________ Date _____________
Page 1

Please print clearly.

Admitted to _____________________________________________________________________________________________________________
Academic level (e.g., 2B) _________
Only where changes are required, indicate the Undergraduate Calendar regulations to be followed for the requested internal transfer.
Academic program calendar year (e.g., 2010-2011) _________________

Academic plan calendar year (e.g., 2010-2011) __________________

Options/minors calendar year (e.g. 2010-2011) __________________

Refused

Defer

Refer to _______________________________________________________________________________

_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Courses required by admitting department.
Primary Meet
Class No.
(4 characters)

Subject

Catalog
Number

Select if Quest enrolment access denied for student (courses to be entered by the Registrars Office)

Primary Meet
Section No.
(3 characters)

Class Number
for Related 1
(4 characters)

Related 1 Section
Number
(3 characters)

Class Number
for Related 2
(4 characters)

Related 2 Section
Number
(3 characters)

Enrolment
Session
(Regular/
Online)

Grading
Basis
(e.g., AUD,
NGP, XTR)

Requirement
Designation
(e.g., XTRA)

Admitting officer approvals (include names, signatures, dates, and extension numbers for joint programs)
Name __________________________________ Signature ________________________________ Date _____________ Extension number ________
Name __________________________________ Signature ________________________________ Date _____________ Extension number ________
Co-operative Education and Career Action approval (if applicable)
Name __________________________________ Signature ________________________________ Date _____________ Extension number ________
Page 2