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Undergraduates Readmission Application Form

Please fill out the form completely. Write N/A where applicable.
For security purposes, the identity of your computer will be recorded.

  Date Of Birth:      Gender:    MaleFemale
  Student ID:
  Email Address:
1. Full Legal Name:
Last First Middle Maiden
2. Name while you were an A&T Student:
Last First Middle Maiden
3. Home Address: 
Street City State Zip
4. Mailing Address (if different): 
Street City State Zip
5. Telephone Number:
Permanent Billing Local
6. Are you applying for on campus housing? YesNo
7. Semester you plan to return:  Year:  
8. What semester and year did you first attend A&T?
9. What semester and year did you last attend A&T?
10. Are you seeking a second degree? YesNo
  If so, please answer the questions below.

  Where did you obtain your first degree?
  What was your date of graduation?
  What is your intended major?
11. Are you returning for undergraduate certification? Yes No
12. Have you attended any other school(s) than A&T? YesNo


If you have attended other colleges/universities, have a transcript mailed to the address below.

North Carolina A&T State University, Admissions Office, 1601 East Market Street, Greensboro, NC  27411
13. Race:

If you are a foreign student, please enter your country of citizenship below.

Your "yes" answer to one or more of the following questions listed below will not necessarily preclude your being admitted. However, your failure to provide complete, accurate and truthful information will be grounds to deny or withdraw your readmission, or dismiss you after enrollment.

  14. Have you been convicted of a crime (other than a minor traffic violation)?
Yes No
  15. Have you entered a plea of guilty, a plea of no contest, a plea of nolo contedere, or an Alford plea, or have you received a deferred prosecution or prayer for judgment continued, to a criminal charge?
Yes No
  16. Have you otherwise accepted responsibility for the commission of a crime?
Yes No
  17. Do you have any criminal charges pending against you?
Yes No
  18 Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any school, college, or university?
Yes No
  19. Do you currently serve in the military?
Yes No
  20.

Have you ever served in the military?
Yes No

If you have ever served in the military, did you receive any type of discharge other than an honorable discharge?
Yes No

If you answered "yes" to any of the questions above, please explain the circumstances. You must notify the Registrar's Office in writing of any criminal charge, any disposition of a criminal charge, or any school, college, or university disciplinary action against you, or any type of military discharge other than an honorable discharge that occurs at any time after you submit this application. Your failure to do so will be grounds to deny or withdraw our readmission, or dismiss you after readmission.


Certification

I hereby affirm that by submitting this form, all information supplied on this form is complete and accurate. I understand that withholding information requested or giving false information may make me ineligible for readmission.