Fillable Application for Readmission (Clarion University of Pennsylvania)

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Application for Readmission (Clarion University of Pennsylvania)

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Clarion University of Pennsylvania
Application for Readmission
Readmission Instructions
1. Students must type directly on this form or print legibly
2. Fax or mail form to:
Check that you have considered the following before deciding to readmit to
the university:
Financial Aid (814-393-2315)
Housing (Please call 814-393-2352 if you need housing)
Holds or other obligations to the University
Registration status (check this on web for students portal)
If you have any questions regarding readmission, please contact the registrar's office at (814)393-2229 or registrar@clarion.edu
Current Name Clarion ID/SSN
Note: If you want your name changed on your record, you must complete the name change form available at www.clarion.edu/registrar/forms
Former Name(s)
Address
Phone
City
State
Zip Code
Are you currently a legal resident of PA?
Yes No
Location Choice: Term of Readmission: Classification:
Clarion
Venango
Pittsburgh
Online
Off-site/Other
Fall
Winter Intersession
Spring
Summer
Freshman (1-29 credits)
Sophomore (30-59 credits
Junior (60-89 credits)
Senior (90+)
Post-baccalaureate
Master's
Post Master's
If you attended another university prior to readmission, you
must request the transferring institution send an official sealed
transcript
directly to the Office of the Registrar, Clarion University, 840 Wood Street, Clarion, PA 16214. Graduate students who have not
attended for one year or more, need to complete an Application for Readmission.
Signature
Date _____________________________
Office of the Registrar - Clarion University of Pennsylvania 8/2018 Page 1
Expected Graduation Term:
Fax: 814-393-2039
Registrar's Office
148 Becht Hall
840 Wood Street
Clarion, PA 16214
registrar@clarion.edu
Doctoral
Yes
No
Yes
Do you have disciplinary actions pending (or charges filed against you) at any previous college?
Have you been convicted of a felony? Yes No
I affirm the above information is correct and that I have read the Consent For The Collection and Processing of Sensitive or
Personal Data from The European Union for Admission and Enrollment Purposes, which has been provided as part of this
Application for Readmission.
County
E-mail
- This e-mail address will be used to confirm your readmission.
Major during your last semester of attendance
Any change of major will require the completion of a Change of Status Form available at www.clarion.edu/registrar/forms
OFFICE USE ONLY
Date Processed _____________ Term ____________
By _________
CONSENT FOR THE COLLECTION AND PROCESSING OF SENSITIVE OR PERSONAL
DATA FROM THE EUROPEAN UNION FOR ADMISSION AND ENROLLMENT PURPOSES
1. Pursuant to the European Union General Data Protection Regulation (EU GDPR), the
Pennsylvania State System of Higher Education and its member universities, including Clarion
University of Pennsylvania (“University”), in its capacity as a data controller under the EU GDPR,
must obtain explicit, affirmative consent before it can collect or process any sensitive or personal
data for a lawful basis including for admission and enrollment purposes.
2. Sensitive data includes data revealing racial or ethnic origin; political opinions; religious or
philosophical beliefs; trade union membership; genetic or biometric data; health data; or data
concerning a person’s sex life or sexual orientation.
3. Any sensitive or personal data that is collected will be for the sole purpose of application for
admission to the University that is sent from the EU and is necessary for that purpose or for any
purpose permitting the use of sensitive or personal data under applicable law or to meet other
compliance obligations of the University.
4. I understand that any sensitive or personal data that is collected will also be used to report
serious illness, injury, or other health or emergency situations involving me, as well as to address
or report discrimination, harassment, sexual or gender-based misconduct and criminal behavior
which may be committed by or against me or otherwise involve me, on or off campus, to
appropriate authorities including staff, faculty, and administrators of the University or
appropriate legal or governmental authorities under applicable policies of the Pennsylvania State
System of Higher Education or the University (including but not limited to applicable codes of
conduct) and applicable laws (including but not limited to Title IX and the Clery Act).
5. I understand that refusal to consent to the use of sensitive or personal data, and the transfer of
sensitive or personal data overseas, for the purpose outlined in this notice may make it impossible
for the University to carry out necessary activities, and may preclude the University’s ability to
provide requested services.
6. I understand I have the right to withdraw consent to the collection and processing of sensitive
or personal data and to do so, I must contact clarion-privacy@clarion.edu. I also understand that
the complete deletion of data will not be feasible in all situations to ensure the University’s ability
to comply with regulatory requirements.
Office of the Registrar - Clarion University of Pennsylvania 8/2018 Page 2
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Application for Readmission (Clarion University of Pennsylvania)

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Completed 22 July 2020

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