Request for Readmission

Page 1

Personal Information

Title

First Name

Middle Name

Last Name

Birth/Maiden Name

Suffix

Preferred Name

Non-Flagler Email

Verify Email

Social Security Number

Current Mailing Address

Street Address

City

State or Province

Zip/Postal Code

Country

Contact Information

Mobile Phone

I give permission to Flagler College to send me important updates via text messaging.
(Standard message charges apply.)

YesNo

Page 2

Program Information

Please provide your previous dates of Enrollment:

Starting Enroll Date

Ending Enroll Date

Which Campus are you looking to re-enroll?

Semester Requesting for Readmission:

Please select a preference for a program option :

Semester Requesting for Readmission:

Are you requesting to return as a Full Time or Part Time student?

Major you intend to pursue upon returning to Flagler College:

Are you planning to be live on or off campus?

Page 4

Why would you like to return to Flagler College?

Since the time you last attended Flagler College, have you been convicted of a felony?

YesNo

Please explain your conviction:

I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment or any appropriate disciplinary action. I authorize Flagler College to verify the information I have provided with all the schools I have attended. I agree to notify the proper officials of the institution of any changes in the information provided. I grant my high school(s)/secondary school(s) and/or college(s) permission to release my transcript(s) to Flagler College.

Flagler College does not discriminate on the basis of sex in its education programs and activities, including in admissions. Inquiries regarding Title IX may be referred to the Title IX Coordinator, to the Assistant Secretary for Civil Rights at the United States Department of Education Office for Civil Rights (OCR) or both. Contact information for the above referenced Title IX Coordinator and OCR as well as the College’s Sexual Harassment Policy can be found here: www.flagler.edu/title-ix.

Form Operations

School 1 ID

School 2 ID

School 3 ID

Alt Email

Academic Dismissal	COVID-19	Education Department Testing Requirements
Family Emergency	Financial Reasons	Medical Withdrawal
Needed to Travel	Study Abroad/Exchange Program	Suspension/Student Handbook Violation
Transferred to Another College	Other