SHUID #:
Last name: First name:
Middle/Maiden Name:
SHU Email Address:
Street Address:
City: State: Zip:
Division: --Select-- Full-time Day Part-time Day Part-time Evening Year: --Select-- 1L 2L 3L 4L
Which Semester do you want this to become effective? --Select-- Spring Fall
Year to be effective: --Select-- 2009 2010 2011 2012
Please descrive your request completely; give reasons.
Change of Division From: To:
"I understand that if this application is approved, I must comply fully with all requirements including residency set forth by the School of Law." --Select-- Accept
