Office of the Registrar September 2011
Returning Student Record Update
Mail/Fax to: Records and Registration Office
5057 Woodward, Fifth Floor
Detroit, MI 48202
Phone: (313) 577-3531
Fax: (313) 577-0945
Drop Off: Student Service Center Lobby
Welcome Center
42 W. Warren
Detroit, MI 48202
Phone: (313) 577-2100
If you have not attended Wayne State for several years, it possible that you will be unable to register for classes
until your record has been updated. Complete this form and deliver it or fax it to the Office of the Registrar. In
researching your record, we will apprise you of any hold we find and advise you on the procedure for clearing
them. In some cases, this may involve you consulting with other offices on campus before this form can be
processed. If we have questions, we will be in touch with you either by phone or e-mail.
Student ID or SSN
Last Name First Name
Previous Names (maiden, or other names you have used)
Birth date
Level of Re-entry
___ Undergraduate
___ Post-Bachelor (note that courses taken as post-
bachelor CAN NOT be applied to a graduate degree.)
___ Graduate
___ Professional
Term/Year of Re-entry
Term/Year Last Attended
Complete Mailing Address
State of Legal Residence
Telephone
E-mail Address
Do you consider yourself to be
Hispanic/Latino?
___ Yes ____ No
In addition, select one or more of the following racial categories to
describe yourself:
___ American Indian or Alaska Native ___ Asian
___ Black or African American ___ White
___ Native Hawaiian or Pacific Islander
Country of Residence
Are you a U.S. Citizen? If no, have you ever had a Visa?
If yes, what type(s)?
Signature
X
Date
Entered by Date Notes
Clear
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