Undergraduate Request Form For Readmission printable pdf download

UNDERGRADUATE REQUEST FOR READMISSION

Mail to: Office of the Registrar, 264 Centennial Drive STOP 8382, Grand Forks, ND 58202-8382 OR Fax to: 701-777-2696

Student ID Number: ____________________________________________

Date of Birth: _________________________________________________



Preferred method of communication for readmit correspondence:

Postal Mail

1. When do you plan to re-enter UND? ______________ Semester: Fall ______ Spring ______ Summer ______

Year

2. When did you last attend UND? __________________ Semester: Fall ______ Spring ______ Summer ______

Year

3. Legal Name: __________________________________ _________________________________ __________________________ ______________________________

Last

First

Middle

Former Name if Applicable

4. Mailing Address: ________________________________________ ______________________________ ___________ ________________ _____________________

Street

City

State

Zip Code

Phone Number

5. Permanent Address: _____________________________________ ______________________________ ___________ ________________ ______________________

Street

City

State

Zip Code

Phone Number

6. Email Address: ________________________________________________________________________

NOTE: If you have changed your residency since your last enrollment, please contact Student Account Services.



a. Are you Hispanic/Latino?

Yes



b. Race/Ethnicity:

American Indian or Alaskan Native

Asian



Black or African American/Black

Native Hawaiian or other Pacific Islander

White



8. Are you a member or Veteran of the Armed Services?

Yes

If yes,



a. Which of the following are you a member of?

Army

Navy

Air Force

Marines

Coast Guard

National Guard



b. Are you:

Active Duty

Reservist

Veteran

Dependent/Spouse



c. Are you returning to UND following active military service?

Yes

9. Please indicate the major you wish to enter ________________________________________________________________________________________________________

**Readmission to the University does not guarantee admission to a particular degree program at the University**

10. Have you attended any other college since you last attended UND? Yes _________ No _________

If yes, Name of College

Dates attended _________________________________________

Name of College

Dates attended _________________________________________

Name of College

Dates attended _________________________________________

**Failure to list all colleges and universities may result in dismissal or loss of credit**

(Official transcript must be forwarded to the University of North Dakota, Office of the Registrar, STOP 8382, 58202, BEFORE YOUR REQUEST FOR READMISSION WILL BE PROCESSED)

Signature ________________________________________________________________________________ Date ________________________________________________

For Office Use Only:

Readmitted: _______________

Probation: _______________

Fall: _______________

Spring: _______________

Summer: _______________

Date:

College:

Program: ____________________________

Credits: ___________________

GPA: _______________ Last Attended: ____________________________ Approved By: ___________________