Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Year 2010 2011 2012 2013 2014 2015
City, State, and Zip
Student ID Number
Best Phone Contact Number(s)
Last Semester Enrolled at UNI
Semester Requesting Readmission
These Circumstances Prevented Me From Achieving Good Academic Standing at UNI (Check All That Apply)
Academic Success Assessment
Personal Issues: Select All Personal Issues That Have Been a Concern for You
If You Selected "Other" In the Above Personal Issues Question, Please State
Please Elaborate If One of the Personal Issues Selected Above Interferes on a Regular Basis
Academic Issues: Select All Academic Issues That Have Been a Concern for You
If You Selected "Other" In the Above Academic Issues Question, Please State
Please Elaborate If One of the Academic Issues Selected Above Interferes on a Regular Basis
Institutional Issues: Select All Institutional Issues That Have Been a Concern for You
If You Selected "Other" In the Above Institutional Issues Question, Please State
Please Elaborate If One of the Institutional Issues Selected Above Interferes on a Regular Basis
The Personal, Academic, and/or Institutional Factors That Have Affected Your Academic Success the Most Are
How Have the Aforementioned Personal, Academic, and/or Institutional Factors Been Reduced or Eliminated?
Why Do You Feel You Can Now Be Academically Successful?
College(s)/University(ies) Attended Since Last Enrollment at UNI (Provide a Copy of All Transcripts with Your Application)
Declared or Prospective Major at the Time of Your Last Enrollment at UNI
If Readmitted, Would You Continue With This Major?
If No, What Would Your Major Now Be?
Why Do You Feel This is an Appropriate Academic Program For You?
Since Your Suspension, With Whom at UNI Have You Had Contact Regarding Your Educational Goals & Academic/Personal Circumstances?
Outline Your Specific Personal Goals and Plans to Improve Your Academic Success if You Are Readmitted
List the Specific Courses You Plan to Complete in Your First Semester After Readmission
List Employment and/or Other Activities Participated in Since Last Enrollment at UNI
Do You Plan on Being Employed if You Are Readmitted to UNI?
If Yes, How Many Hours Do You Plan to Work Per Week?
- None - 0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 40+
I Want to Schedule an Individual Meeting to Discuss My Readmission Application with the Committee on Admission and Retention?
If Yes, a Representative of the Office of the Registrar Will Contact You to Schedule an Appointment During a Regular Committee Meeting Time.
By Providing Your Full Name, You Acknowledge Having Read, and Agree With, the Confirmation Statement
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