___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Application for
Undergraduate Readmission to the University
Department of Interest/Major
To the applicant: Prior to returning to the University, you will need written approval from the department
in which you intend to major. If you have not yet decided on a concentration, choose the department in
which you have the strongest interest. Please complete this form and submit it to the Office of the
Registrar. If you are readmitted, you must fulfill the requirements of the major that are in place at the
time of your readmission.
Name: _____________________________________________ Student ID: _____________________
Address: ___________________________________________________________________________
Daytime telephone: _________________________________________________________________
Email address: ______________________________________________________________________
Proposed semester of return to the University: _____________________________________________
Department of intended major: ________________________________________________________
To be completed by the department representative. Please review this readmission request promptly (see
attached student statement and academic transcript) and return it to the Office of the Registrar
(registrar@simmons.edu).
The department ____ approves ____ denies
this student’s application for readmission.
The following conditions must be met before readmission can be approved:
If denied, please indicate reason(s) : ____________________________________________________
Signature of department representative: _______________________ __________________________
Date: _____________________________________________________________________________
03/20/19
click to sign
signature
click to edit