APPLICATION FOR READMISSION

Formal application for readmission is required whenever a student fails to register for a regular (fall/spring) semester, whether the student had an approved leave of absence or withdrew. Readmission does not extend the original 5 year/ master or 8 year/doctoral completion period.

This application must be completed in one sitting

Applicant Information

UNC PID (Person ID Number)

Last (Family) Name

First (Given) Name

Middle Initial

Biographical History

Birthdate

Gender

Citzenship

Citizenship

Permanent Resident

Country of Birth

Contact Information

Home Address

Country

Street

City

Region

Postal Code

Mailing Address

Country

Street

City

Region

Postal Code

Phone

Preferred Phone Type

Preferred Phone

Email

Preferred Email

Program Data

Admit Term

Degree

Plan Data

Major

Residency

Your residency for tuition purposes determines your in-state or out-of-state status and may impact your tuition, scholarship or financial aid eligibility. North Carolina residency for tuition purposes is governed by North Carolina state law. More information about North Carolina residency for tuition purposes can be found at www.ncresidency.org.

Yes, I claim to be a North Carolina resident for tuition purposes.*

No, I do not claim North Carolina residency for tuition purposes. I understand I will be charged the non-resident tuition rate if enrolled at a North Carolina state-supported institution.

*If you claim to be a resident, you must complete the residency process with the Residency Determination Service (RDS) at www.ncresidency.org. The RDS will provide you with a Residency Certification Number (RCN), which you may enter below. If you do not enter your RCN below, you will receive additional RCN submission instructions after your application has been received.

RCN:

Campus Safety

Since your last enrollment at UNC-Chapel Hill, have you:

1) Been convicted of a crime?

Yes

No

If you answered "Yes' to the above question, please use this space to explain your response

2) 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

If you answered 'Yes' to the above question, please use this space to explain your response.

3) Accepted responsibility for the commission of a crime?

Yes

No

If you answered 'Yes' to the above question, please use this space to explain your response.

4) Have any criminal charges pending against you?

Yes

No

If you answered 'Yes' to the above question, please use this space to explain your response.

5) Been dismissed, suspended, expelled, placed on probation, or otherwise subject to any
disciplinary sanction by any school, college, or university?

Yes

No

6) Served in the military and/or received any type of discharge other than an honorable?

Yes

No - Never served

No - Currently serving

No - Honorable discharged

Required Community Standards Documentation

If you answer 'Yes,' to any of the above questions, in addition to your own explanation, you are required to provide supporting documentation.

You must also promptly notify the Admissions Office in writing if any of the above information changes after you submit this document. Your failure to provide complete, accurate and truthful information on this document will be grounds to deny or withdraw your readmission or dismissal after enrollment.

Student Signature:

In place of your signature, please type your full legal name:

Date: