University of California, Berkeley
Undergraduate Application for Readmission
Please read these INSTRUCTIONS carefully. Complete the application and submit it directly to your College/School advising office.
There is a non-refundable application fee of $70. Please select your payment method:
My check or money order payable to UC Regents is enclosed; OR Please send me instructions to pay online
Fall 20 Spring 20
Term for which you are Reapplying:
UC Berkeley Student ID Number:
Date of Birth:
Name as last Registered at UC Berkeley (If your name has changed, please submit a Petition for Change of Name):
Last Name, First Middle
Contact Information:
Email Address Local Phone Permanent/Home Phone
Mailing Address:
Street City State ZIP
Permanent/Home Address:
Street City State ZIP
Fall Spring Summer Year
Fall Spring Summer Year
College or School Major
First Enrolled at UC Berkeley:
Last Enrolled at UC Berkeley:
I was last enrolled at UC Berkeley:
I am reapplying to UC Berkeley:
College or School
Major
I expect to graduate: Fall Spring Summer Year
I have not attended/am not attending another institution while absent from UC Berkeley
If you have attended ano
ther college or university while absent from UC Berkeley, please provide the following:
Dates:
Institution City State ZIP From To
Dates:
Institution City State ZIP From To
Applicant’s Signature: Date:
Signature of Dean or
Dean’s Representative: Date:
Dean’s Approval Required for All Students
Approval of Expected Grad Term
Adviser Initials:
Office of the Registrar Use Only
Date Received RADM Date Staff Initials
Blocks Yes No
Payment
Yes No
Received
