Jacksonville University
Application for Readmission

2800 University Blvd. N.
Jacksonville, FL 32211
Fax (904) 256-7086

 

This form is needed if the student was not enrolled for the most recent fall or spring term. It serves as a notice of interest to reenroll. It should be submitted to the Registrar's Office at least one month before registration for any term so the necessary preparation can be made.

Mr./Miss/Ms./Mrs./Other ____________________________________________________
                                            Last                            First                Middle/Maiden

Name(s) under which you were last enrolled, if different from above:__________________________________________

Dates of last enrollment at Jacksonville University From:_____________ To:______________

When do you plan to reenter? ____________________
                                                        Semester/year

Social Security Number: __________________ JU ID#: ___________________

Permanent address: ______________________________________________________
                                    Number                Street                City                State            Zip

Local address (if different):___________________________________________________
                                            Number                Street                City                State            Zip

Permanent telephone: (_______)_____________ Local # (if different) (____)______________

Daytime phone: (_______)_______________ Email address: ___________________________

Check one: 
White Non-Hispanic ____ African American ____ Hispanic/Latino ____ Multi-Ethnic ____ 

Asian or Pacific Islander ____ American Indian or Alaskan Native ____ Other ____

Religious preference: _______________________

If you are a non-resident alien or a non-resident of the state of Florida, list country name or state in which you are a legal resident: _________________________________

If you are a legal resident of Florida, list the county in which you are a legal resident: ___________

I am reapplying as (check one):

____Traditional Undergraduate	____Business EMBA - Graduate
____Transient Undergraduate - Non-degree	____Education MAT - Graduate
____Adult Degree Undergraduate	____Education Transient - Graduate
____Business MBA - Graduate	____Education Non-degree - Graduate
	____Education SCAAT - Graduate

My intended major  or area of certification is:__________________________ 

Check and complete either statement I or II as applicable

____ I. I have attended the following colleges or universities since my last enrollment at Jacksonville University.

________________________________________________________________________

Are you currently enrolled? _____Yes ____No

 

____ II. I certify that I have attended no other college or university since last enrolled at Jacksonville University.

Would you like certification for veterans benefits? ___Yes ___No

 

Signature: ____________________________ Date: _______________