Intent to Re-Enroll

PLEASE COMPLETE THIS FORM IF YOU ARE A FORMER UNIVERSITY OF DAYTON STUDENT AND WISH TO RETURN.

Step 1 of 4

Personal Data

First Name

Middle Name

Last Name

Previous Name (if different)

Month

Day

Year

Date of Birth (mm/dd/yyyy)

Student ID Number

Local Home Address

City

State/Province

Zip/Postal Code

Permanent Home Address

City

State

Zip/Postal Code

Phone Number

Email Address

Step 2 of 4

Academic Information

Please enter Re-entry Term and Year

Have you attended another college or university since you were last at UD?

If Yes, please list the school(s) and dates of attendance:

Step 3 of 4

Additional Information

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in disciplinary action?

If yes: Please provide details that give the approximate date of each incident and explains the circumstances.

Have you ever been adjudicated guilty or convicted of a misdemeanor or felony? Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential.

If yes: Please provide details that give the approximate date of each incident and explains the circumstances.

Step 4 of 4

Statement of Applicant

_{I certify the information on this application is complete and correct. I understand any deliberate attempt on my part to conceal or modify any information is adequate cause for denial of this application for admission or dismissal from the university.}

_{I hereby request readmission to the university and understand that the college into which I request this readmission has the final decision, as per University policy.}

Electronic Signature

Submit

CONTACT

Flyer Student Services

St. Mary's Hall
300 College Park
Dayton, Ohio 45469 - 1600

Intent to Return Form