Fillable Re-Activation Application Office of Undergraduate Admissions (Azusa Pacific University)

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Re-Activation Application Office of Undergraduate Admissions (Azusa Pacific University)

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Page 1 of 2
Re-Activation Application
Office of Undergraduate Admissions
Term Re-Applying for: ________________
_________________________________________________________________ ___________________
First Name Middle Initial Last Name Maiden Name (if applicable) APU ID Number (###-##-####)
_________________________________________________________________ ___________________
Address: Number & Street Apartment/Unit Date of Birth (mm/dd/yyyy)
_________________________________________________________________ ___________________
Address: City State/Province Postal Code Country Social Security # (###-##-####)
_________________________________________________________________
Home Phone Preferred? Cell Phone Preferred? Email Address Gender:
Do you plan to…
enroll as a full-time student? Citizenship:
live on campus?
apply for financial aid?
Church Information Do you have a personal relationship with Jesus Christ?
Name: _____________________________________________
City: ______________________________________________ How often do you attend church related activities?
State/Province: ______________________________________
Denomination: ______________________________________
Azusa Pacific University is an institution built on Four Cornerstones, which define why APU exists:
• Christ (God First since 1899!)
• Transformational Scholarship (strong academic programs that develop your character and prepare you for your future)
• Life-giving Community (a campus environment that encourages involvement and dynamic relationships)
• Sacrificial Service (a culture of serving others and giving of yourself)
Are you readily willing to embrace these Four Cornerstones as you consider the educational, social, and spiritual
environment at Azusa Pacific University?
Have you ever been found guilty, or responsible for,
any criminal or military offense, excluding minor
traffic violations, either as a juvenile or an adult?
(If yes, please explain )
Attach separate sheet if necessary
Have you ever been academically dismissed from,
declared ineligible to attend, or incurred disciplinary
action at any institution?
(If yes, please explain )
Attach separate sheet if necessary
This form should be completed using the latest version of Adobe Reader,
which you can download here for free. After the form is complete, please
print, sign, and submit it to the Office of Undergraduate Admissions.
Male
Female
US Citizen
Permanent US Resident
Non-US Citizen
Yes No
Yes No
Yes No
More than once weekly Weekly
Monthly Rarely
Yes No
Yes No
Yes No
(Please contact me for details)
Semester Year
NOTE: Students completing this application must have submitted an Undergraduate Admissions application within the last two years.
Page 2 of 2
Re-Activation Application
Office of Undergraduate Admissions
Parent/Guardian Information
Parent/Guardian 1
______________________________ ______________
First Name Last Name Phone Number
_____________________________________________
Street Address City State Zip
Parent/Guardian 2
______________________________ ______________
First Name Last Name Phone Number
_____________________________________________
Street Address City State Zip
Relationship (Check One): Father Stepfather
Mother Stepmother
Legal Guardian
Relationship (Check One): Father Stepfather
Mother Stepmother
Legal Guardian
Previous Education Information: In the space below, please provide the requested information for ALL colleges &
universities attended. If you have taken courses at more than 5 institutions, please provide the requested information for
each additional institution on a separate page.
_____________________________________________ _____________________ ______________
College Name From (mm/yyyy) To (mm/yyyy) Credits Completed
_____________________________________________ _____________________ ______________
College Name From (mm/yyyy) To (mm/yyyy) Credits Completed
_____________________________________________ _____________________ ______________
College Name From (mm/yyyy) To (mm/yyyy) Credits Completed
_____________________________________________ _____________________ ______________
College Name From (mm/yyyy) To (mm/yyyy) Credits Completed
_____________________________________________ _____________________ ______________
College Name From (mm/yyyy) To (mm/yyyy) Credits Completed
Please indicate the academic major you plan to study at APU: ________________________________________________
Please sign below, indicating that you understand and agree to the following:
• I certify that the information on this form is complete and correct to the best of my knowledge. If my application is
accepted, I agree to abide by the policies, standards, and regulations at Azusa Pacific University and respect the ideals,
principles, and traditions it upholds as a Christian institution of higher learning. I further understand that this
information will be relied upon by the officials of the university in determining my admission status and that the
submission of false information is grounds for rejection of my re-enrollment application, withdrawal of an offer of
acceptance, dismissal from the university, revocation of a degree, and/or other disciplinary action.
_________________________________________________________________ ___________________
Signature Date
Office of Undergraduate Admissions • Azusa Pacific University • PO Box 7000 • Azusa, CA 91702
Phone: (626) 812-3016 • Fax: (626) 812-3096 • Email: admissions@apu.edu
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Re-Activation Application Office of Undergraduate Admissions (Azusa Pacific University)

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Completed 17 August 2020

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