READMISSION APPLICATION

Students who have interrupted their course of study for at least two semesters must apply for readmission.

“If you have not registered for the upcoming semesters, you will be eligible to apply for readmission for the Spring 2013 Session. You may appeal this suspension by following the steps in the enclosed Suspension Appeal form. No appeal is guaranteed…..”

Your failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw your admission, or dismiss you after enrollment. By signing this application, you are granting permission for a criminal background check if deemed necessary. Please note there is a $25.00 readmission fee that must be paid prior to processing your application.

If you are a Regional Licensure student please contact the Licensure Office.
If you are taking graduate level courses please contact the School of Graduate Studies.

Provide the following information.

Last Name

First Name

Middle

Sex

If you attended UNC Pembroke before under a different name please indicate that name here.
Last Name	First Name	Middle

Student ID
no hyphens or spaces

Date of Birth
mmddyyyy

Ethnicity
Select one of the following

Marital Status

Not Hispanic or Latino

Hispanic or Latino

Race
Choose all that apply

Notice: Permanent address can NOT be a dormitory type address

What is your permanent street address?

Street

City

State/Province

Zip Code

Country

Home telephone

Work telephone

Email address

Yes	No	Have you attended any other academic institutions since you last enrolled at UNC Pembroke? If you answered yes to this question, you must list all academic institutions you have attended since leaving UNC Pembroke below.

Choose your track of study (Required)

NOTE: If you wish to enter the ONLINE Bachelor of Science in Business Administration,
you must contact Dr. William Thomas (william.thomas@uncp.edu) to have your major
confirmed before you can register for any online business courses.

What will your entry status?
Freshman	Sophomore
Junior	Senior
Second Four.Year Degree	Audit
Enrichment Seeking.... (No Financial Aid)	Certification/Renewal

When do you plan to return to UNC Pembroke?
Fall	Spring
Summer I	Summer II

Tell us in your own words what you have been doing since leaving UNC Pembroke.

When did you last attend UNC Pembroke?

Month

Year

Have you complied with the North Carolina Immunization Law?

yes

All students must comply with the North Carolina immunization laws. Returning students that fail to demonstrate compliance will be cancelled from their classes and withdrawn from the university. Please contact UNC Pembroke's Student Health Services

Campus Safety Questions
Your "yes" answer to one or more of the following questions 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 admission, or to dismiss you after enrollment.
For the purpose of the following six questions, "crime" or "criminal charge" refers to any crime other than a traffic-related misdemeanor or an infraction. You must, however, include alcohol or drug offenses whether or not they are traffic related.

Have you been convicted of a crime?	Yes No
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea, or have you received a deferred prosecution or prayer for judgment continued, to a criminal charge?	Yes No
Have you otherwise accepted responsibility for the commission of a crime?	Yes No
Do you have any criminal charges pending against you?	Yes No
Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any institution of higher education?	Yes No
If you have ever served in the military, did you receive any type of discharge other than and honorable discharge?	Yes No Current Military Status: (Required)

If you answered "yes" to any of the six questions above, please explain the circumstances below.
If you answered "no" then type "N/A" in this box to finish.

You must promptly notify the Office of the Registrar 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 a honorable discharge that occurs at any time after you submit this application. Your failure to do so will be grounds to deny or withdraw your admission, or to dismiss you after enrollment. By signing this application you are granting permission for a criminal background check if deemed necessary.

North Carolina Residency
North Carolina law (G.S. 116-143.1) states that in order to determine eligibility for the in-state tuition rate, "Every applicant for admission shall be required to make a statement as to the length of residence." The following information should allow for an accurate determination of residency status. If the total time listed below is less than 12 months, please list additional addresses (and length of residency) on additional sheet. you will be contacted if additional information is needed.

Are you a legal resident of North Carolina?

yes

Has your residency changed since you last attended UNC Pembroke? If you answered yes, please submit the North Carolina Residence and Tuition Application.

yes

I UNDERSTAND THAT WITHHOLDING INFORMATION requested in this application or giving false information may make me ineligible for admission to/or continuation at The University of North Carolina at Pembroke. With this in mind, I certify that the statements herein are correct and complete. I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment.

Note: This application is not complete until you have successfully

This publication is available in alternative formats upon request.
Please contact Disability Support Services, DF Lowry Building, 521-6695.

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