Application-for-Re-Admissions-FVSU

Fort Valley State University Office of the Registrar Office of the Registrar \ A State and Land-Grant University 1005 State University Drive.. - Fort Valley, Georgia 31030-4313 Universit

Fort Valley State University Office of the Registrar

Office of the Registrar

\

A State and Land-Grant University 1005 State University Drive - Fort Valley, Georgia 31030-4313 University System of Georgia

APPLICATION FOR RE-ADMISSION

 Read carefully prior to completing each item.

 Print all items completely and accurately.

 Sign and date the completed form.

Note: To ensure adequate processing time for regular enrollment activities, this form must be

submitted to the Office of the Registrar 20 days prior to the start of the term

I wish to re-activate my files for: □ Summer □ Fall □ Spring

Year: _

□ Ms □ Mrs □ Mr E-mail address:

ID#: _- _- _ Telephone: ( )

_

Home Address: _

City: _

County of Residence: State:

Zip: _

Gender: □ Male □ Female Marital Status: □ Single □ Married □ Divorced □ Widow

Race: _ Date of Birth: _ / / _

How long have you maintained legal residence in Georgia? Years

Are you a veteran? □ Yes □ No

Previous enrollment at FVSU: Term: _

Year: _

What is your intended major?

_

Have you attended another accredited college/university since your last attendance at FVSU?

If yes, please complete information below:

478.825.6282 ▪ Fax 478.825.6155

An Equal Opportunity, Affirmative Action Institution

College/University Location Dates Attended

Note: Failure to provide information concerning other collegiate enrollment(s) will provide grounds for immediate dismissal Official transcripts are required from each institution attended Transcripts must be received prior to processing this form.

I certify that the information provided is accurate and complete.

Signature: _

Date:

Revised: August 1, 2007

478.825.6282 ▪ Fax 478.825.6155

An Equal Opportunity, Affirmative Action Institution