OFFICE OF THE REGISTRAR
MSC 105, 1050 W. SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
www.tamuk.edu
REQUEST FOR READMIT AFTER ONE YEAR NON-ATTENDANCE FORM
(Please Use Black or Blue Ink Only)
This form is required of all students who have not been enrolled (taken a course) at Texas A&M University-Kingsville
(TAMUK) during the past year and now wish to re-enroll. NOTE: If you have not attended TAMUK for 2 or more years,
you will need to apply for re-admission with the appropriate admitting office.
Semester requesting to return: ___ Fall ___ Spring ___ Summer 20_____ Student ID #_________________________
_____________________________________________________________________ __________________________
(Last Name) (First Name) (Middle Initial) Date of Birth
_________________________________________________________________________________________________
Street Address or P.O. Box (Apt. #) City State Zip Code
Phone: ____________________________ Email Address: _____________________________________________
Name under which previously attended (if different than above): ______________________________________________
Classification (choose one): UG GR DR Major(s): __________________________________________________
(UG ONLY) Minor(s): _________________________________ Concentration (if applicable): _____________________
Last term of attendance at TAMUK: ______ Fall _____ Spring _____ Summer
Year: ______________
No
Have you received the Bacterial Meningitis Vaccination in the last five (5)
years? If yes, date taken? _____________________________________
Were you in good academic standing when you left TAMUK? Yes No
If no, you may be required to obtain an approval letter from your advisor. If required, the Office of the Registrar must
receive the approval letter prior to processing the Request for Reinstatement.
Have you attended another institution since your last enrollment at TAMUK?
Yes
No
If yes: Name of Institution(s):
____________________________________________________
____________________________________________________
Date(s) Attended (From To):
_______________________________________
_______________________________________
I certify that the answers given on this from are correct and complete to the best of my knowledge. I understand that false
statements could result in my dismissal from Texas A&M University-Kingsville.
Signature: __________________________________________ Date: ______________________________
Note: It is your responsibility to forward your official transcript from any/all college(s) you attended since your last enrollment at
TAMUK. Please be sure all transcripts are mailed to the Office of Admission or hand delivered in a sealed envelope to the Javelina
Enrollment Services Center located in the Memorial Student Union Building.
Office of the Registrar’s Use Only: Processed by: ___________________ Date: ___________________
03/09/2016
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