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A copy of this form will be sent to the Center for Academic Support.
This form should be submitted at least two months prior to the beginning of the semester to which an applicant seeks readmission.
Date you wish to re-enter: September or January
Applicants who have studied at other institutions since leaving the University should have official transcripts of all college courses completed sent by the instituitions directly to the College Center for Academic Support, Lattimore Hall 312, R.C. Box 270402, University of Rochester, Rochester, NY 14627. Yes, I am sending transcripts.
Last Name: First Name: M.I.:
Gender: Male Female Date of Birth: Student ID/SSN:
E-mail:
Home Address:
City: State: Zip: Phone:
If different from above, please give present mailing address:
To be used until:
Institution(s) attended since leaving the University of Rochester:
Previous attendence at the University of Rochester
Dates you attended the University (months and years): From to
Originally a member of the Class of:
Degree program enrolled in at the time you left:
Why did you leave the University of Rochester?
Did you withdraw voluntarily? Yes No
If so, were you in good academic standing at the time? Yes No
What degree program do you plan to follow upon readmission?
Do you plan to attend full-time or part-time? Full Time Part Time
Please list all employment and/or study undertaken since leaving the University?
Campus Housing
If accepted, will you be applying for campus housing? Yes No
Personal Statement
In the space below, briefly explain your educational plans and objectives in pursuing further study at the University of Rochester. (If you did not withdraw voluntarily, please be sure also to describe your activities since leaving the University, and reflect upon your experiences.)
