Re-Admission Revised 3/2018 Page 1 of 1
Application for Graduate Re-Admission
If your matriculation has been closed due to an absence of one calendar year or more, you must complete and submit an Application for
Graduate Readmission. Admissibility and catalog eligibility will be determined upon readmission. All supporting materials detailed in the
Guidelines for the Re-admission Process must accompany this form and be submitted to the College of Graduate Studies. A fee of $50 is
assessed for the re-admission process. This fee is applied to your student account at the time the re-admission process is completed.
PLEASE PRINT Note: The address and e-mail information that you provide will be used to update our records.
Name: _____________________________________________________ Previous Name(s) _______________________________
Last First Middle
SSN/Rocket ID: _____________________ Birth Date: ________________ E-mail Address: ________________________________
Local Address: _______________________________________________________________________________________________
Number Street Apartment No. City State Zip
Permanent Address: ___________________________________________________________________________________________
Number Street Apartment No. City State Zip
Local Phone: (_____)_______________ Last Attended UT: ______________ Previously Enrolled Program: ____________________
Year/Term
Emergency Contact Information:
Name: _________________________________ Relationship _________________ Local Phone: (_____)____________________
Last First
Address:
Number Street Apartment No. City State Zip
List Colleges/Universities attended since your last enrollment at UT:
(transcripts are required from these institution(s))
________________________________________________________________________ ____________________________________________________________
Institution Dates Attended Institution Dates Attended
RESIDENCY HISTORY
Most recent dates you have lived in Ohio (choose one): □ Birth to Present □ From _____/_____to_____/_____ □ Never
Month Year Month Year
If you have lived in Ohio less than 12 months, your previous state of residency was: _______________________________________
If you are a resident of Michigan, please indicate the County of residence and the dates you lived there.
County of Residence: ___________________ Dates of Residency:
□ Birth to Present □ From _____/_____to_____/_____
Month Year Month Year
If you believe that your residency status has changed since last attending the University of Toledo, you must complete the Application for Non-Resident Fee Exemption
available through the Bursar’s Office. The University of Toledo Residence Committee will review your application to determine if you qualify for a change of status.
STATEMENT OF INTEGRITY
I certify that the information above is true and complete. I understand that withholding information requested or giving false information may make
me ineligible for readmission and enrollment.
Signature: ___________________________________________________________________ Date: ___________________________________
For Academic Program/College Use Only - *Please forward completed form and all materials to the College of Graduate Studies.
College: ___________________ Major: __________________ Degree:__________________ Expected Graduation Term: ____________________
______________________________________________________________________ _____________________________________________________________
Signature of Advisor or Dept. Chair Date Signature of Associate Dean or Designee Date
_______________________________________________________________________________________________________________________________________
For College of Graduate Studies Use Only
All materials received: ________________ Missing: ________________________ Matric. Open: ______________ Matric. Close: _____________
Catalog/Year: ______________ Cumulative GPA: _________________ COGS Approval_____________________________________ □ Banner
Date
Notification to Student/Advisor:_________________________________ Notification to Business Manager: _______________________________
Date of E-mail Date of E-mail
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