University of Dubuque
Wednesday, May 16, 2012
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Office of Admission

Undergraduate Application for Re-Admission

(Former University of Dubuque Students Only
All other students, please use this link)
Required Information is indicated with Red
Personal Information 1. Name Last Name

First Name

Middle Initial Suffix 2. Mailing Address
Number and Street

City

Foreign Province

State-(if U.S.)

Zip-(if U.S.)

Foreign Postal Code

Country
3. Home Telephone (Include Area Code)
4. Cell Phone (Include Area Code)
5. Business Phone (Include Area Code)
6. E-mail
7. Date of Birth (mm/dd/yyyy)
8.Country of Citizenship United States Permanent US Resident(noncitizen) Other(please specify)
Visa Type

9. I am applying for the term beginning



When did you last attend UD?


9. Classification
Enroll as:
Freshman Sophmore Junior Senior
10. Living arrangement
On-Campus Commuting Student
11. Social Security Number


12. Marital Status
Single Married Divorced Separated Widowed
13. Veteran:

No Yes
14. Ethnicity (please select one)

16. Have you attended any colleges during your absence from University of Dubuque?
If yes, please list below.
Please have transcript sent from each college as soon as possible.
Name of School Location (city, state, zip) Dates Attended Country
17. Have you ever been dismissed from any college or university?
No Yes

If yes, for what reason?

Have you ever incurred disciplinary action or have you ever been suspended, placed on probation, dismissed or separated from any college or university?
Yes No

Are you currently in default on any student loans?
Yes No
Educational Plans
18. Possible area(s) of academic concentration/major in college
First choice.

Second choice. 19 If there are special circumstances or concerns affecting your application about which you think we should be aware, please elaborate.

Personal Statement.
20. Please use this space to let us know about issues of importance to you and/or events tht have happened in your life since your first application to the University of Dubuque. Include your reasons for seeking re-admission to the University.

(You may copy and paste a Word document into this space.)

IMPORTANT
We cannot process your application without your verification below.

Misrepresentation in any statement on this application may be considered sufficient reason for refusal of admission or cancellation of registration after acceptance.

I certify that the information given on this application is complete and correct to the best of my knowledge, and that I have not attended institutions other than those listed. I understand that I am responsible for arranging for the forwarding of official transcripts from schools I have attended, and that such transcripts become the property of The University of Dubuque and will not be returned.


Date

Equal Opportunity Policy.

The University of Dubuque admits qualified students regardless of religion, race, sex, color, national or ethnic origin, or handicap to all rights, privileges, programs and activities generally accorded or made available to students at the University. It does not discriminate on the basis of religion, race, sex, color, national or ethnic origin, or handicap in administration of its educational policies, admissions policies, scholarship and loan programs and athletic and other University-administered programs.

Questions regarding such policies and programs should be directed to the equal opportunity coordinator at the University of Dubuque or to the director of the Office for Civil Rights of the US Department of Health and Human Services.


2000 University Avenue • Dubuque, Iowa 52001 • 563-589-3000
The University of Dubuque does not discriminate on the basis of race, color, national or ethnic origin, sex, handicap/disability, or age.
Persons having inquiries may contact the Director of Human Resources, University of Dubuque, 2000 University Avenue, Dubuque, IA 52001-5099.
Phone 563-589-3000

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