Fill - Free fillable APPLICATION FOR RE-ENTRY (California State University Channel Islands) PDF form

APPLICATION FOR RE-ENTRY

Undergraduate students requesting to return to CSU Channel Islands after more than one year away (two regular

semesters not to include Winter or Summer) without having a leave of absence on file, are considered re-entry students.

Re-entry students will not need to re-apply for admission through Cal State Apply, with the exception of impacted programs

such as BS Nursing/BS Mechatronics Engineering and the following self-support degree programs offered through Extended

University: BA Psychology (Santa Barbara/Goleta), BS Business (Santa Barbara/Goleta), BS Business Online, and BS Nursing

(BSN/ADN to BSN/RN to BSN).

Note: Any student who has been academically disqualified will have to go through the formal reinstatement process prior to

being readmitted. If you have been disqualified, please click here: https://www.csuci.edu/academics/appeals/reinstatement.htm

Deadlines for Submission by Term:

FOR RE-ENTRY IN FALL: July 1

FOR RE-ENTRY IN SPRING: December 1

INSTRUCTIONS:

1. Meet with an Academic Advisor in the Academic Advising Center to review academic requirements. You will need to

obtain an advisor’s signature on this form. Visit https://www.csuci.edu/advising/contact.htm

for contact information.

2. If you have completed any coursework since you last attended CSUCI, you must send official transcripts.

3. A decision and/or response will be communicated within 10 business days via e-mail. If application is submitted outside

of normal processing times (April – July 1

for Fall, October – December 1

for Spring), we will notify you that it has

been received. You will receive a separate notification once it is processed.

Name ___________________________________________________ Student ID __________________________

E-mail Address __________________________________________ Phone ________________________________

Date of Birth _______________________________________

Major: __________________________________________________________________________

You must establish a major by 60 or more baccalaureate units.

I wish to return to CSU Channel Islands (Required): Term __________________ Year ________________

Summer and Winter are not valid terms for re-entry. Please visit: https://ext.csuci.edu/ for Extended University enrollment information.

Citizenship/Residency Information (Required)

Country of Citizenship _______________________________________________________

What U.S. State/Posession do you regard as your permanent home? ________________________________________

Do you claim California Residency? (yes/no) ______________________

Have you lived in California continuously since birth? (yes/no) ______________________

If No to the question above, when did your present stay in California begin? (month/day/year)___________________

Enrollment

Management

Registrar’s Office

One University Drive

Camarillo, CA 93012

Phone: (805) 437-8500

Which of the following describes the reason why you stopped attending CSU Channel Islands? (check all that apply)

□

Was not eligibile to return because of grades

□ Could not afford to return

□ Decided to take the semester off

□ Struggled to pass classes

□ Transferred to another institution

□

Could not get the class(es) that I needed

□ CSUCI did not have the major that I was interested in

□ Personal Reasons (health, family situation, etc.)

□ Other ___________________________________

Are you any of the following? (check all that apply)

□ Veteran

□ Military Dependant

□ Not a member of the military

Did you attend any other college/university during your absence from CSUCI? (If yes, fill out the information below)

Institution

Location

Dates of Attendance

Units Completed

(Required)

CERTIFICATION – I certify that my statements on this application are true and complete to the best of my knowledge. I

acknowledge that eligibility to enroll in courses at CSUCI is contingent upon having paid any fees that are owed and taken care of any

account holds. I understand that any misrepresentation of information may be cause for denial or cancellation of admission or

enrollment.

Student’s Name (Printed) __________________________Student’s Signature____________________________ Date _________

Administrative Use Only – Academic Advising

Advisor’s Name (Printed) _________________________Advisor’s Signature_____________________________ Date _________

Major Catalog Year Request: ________________________ GE Catalog Year Request:__________________________

NOTE: Student must have catalog rights to the year requested. If student has not maintained continuous enrollment at a CSU or CA community

college, a Petition for Exception to Academic Policy will be required.

Notes: _______________________________________________________________________________________________

_____________________________________________________________________________________________________

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