Application for Readmission
The Graduate School
VU ID #
Personal Email Address
Full Name
Phone
Student Information
Last Date of Enrollment
Revised 2/17
Reason for Request
Please describe your reason(s) for discontinuing academic work at Valparaiso University. You may attach additional pages as
needed.
Student
Dean
Date
Date
Proposed Date of Re-Enrollment
Please type or print your name as it is officially recorded with Valparaiso University: Family/Last Name, Given/First Name Middle Name Maiden/Former Name
Cumulative GPA
Approved
Denied
Degree Program
Current Address
YearSemester
Please list all other educational institutions attended since you last enrolled at Valparaiso University. You may
attach additional pages as needed.
Other Institutions Attended
Since your last enrollment at Valparaiso University, have you been convicted of a felony or is there a reasonable likelihood
you will be charged with and/or convicted of a felony in the immediate future?
Yes No
If yes, to one or both of the following questions, please provide a detailed explanation below. You may attach additional pages
as needed.
YearSemester
NoYes
Have you ever been placed on probation and/or dismissed by any college, university, or professional school for any reason,
or is there a reasonable likelihood you will be placed on probation and/or dismissed by any college, university, or
professional school for any reason in the immediate future?
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