Application for Undergraduate Readmission
Office of the Registrar
Address 1500 N. Patterson St. • Valdosta, GA 31698–0170
Phone 229–333–5727 • FAX 229–333–5475 • WEB www.valdosta.edu/registrar
Please return all copies to the Office of the Registrar
TM
Name _________________________________________________________ VSU ID # ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Last First Middle/Maiden
Current Mailing Address ______________________________________ or SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Address
___________________________________________________________________________________________________________
City State ZipEmail
___________________________________________________________________________________________________________
Home Phone Work Phone Name at the time of last enrollment, if different ___________________________________________________________________
Classification: (check one) Undergraduate Student
Semester and year in which you wish to return:
Fall (August)
Transient
Spring (January)
Other
Summer (May/June)
Year ____________
If you have earned a four–year college degree, check one of the following:
Seeking Second Degree
Seeking Initial Teacher Certification
Other ____________________________________________
Intended major upon readmission ______________________________________
Note: Any change in major must be made well before any registration period and with the advice and consent of both releasing and accepting departments. Change of major,
name or address forms are provided by the Office of the Registrar. Changing majors may result in taking additional courses to meet new degree requirements. Also, by changing your
major or interrupting your college work for more than a year, you become subject to the graduation requirements of the current catalog. Further, the following professional programs
have separate requirements for admission to their upper division courses: Education, Nursing and Business Administration. Consult the current catalog for details.
Please list all institutions you have attended below. The VSU Office of Admissions must have an official transcript from each
institution before you can be processed for re-admission.
Institution NameDates AttendedDid you graduate?
________________________________________ __________________________
yes
no
________________________________________ __________________________
yes
no
________________________________________ __________________________
yes
no
________________________________________ __________________________
yes
no
Are you applying for in-state tuition: yes
no
False swearing language: I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached
hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offence of false swearing shall be punished
by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I
further understand that any such false statement may subject me to immediate dismissal from the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Student’s Signature ___________________________________________________________ Date _______________________
You must be advised by the department of your major before you can access the registration system.
If you do not enroll for the semester listed, this re-admission is void and a new one must be submitted.
Do not write below this line - Office Use Only
Non-suspension
Number of Suspensions
Processed by:
Re-admission Cleared
Re-admission is approved ____ denied ____
Admissions ________________ Date __________
Date ___________ Probation _____Yes _____ No
Conditions:
Registrar __________________ Date __________
Earned Hours _____ GPA Hours _____ Transferred _______
___ Must Maintain _____ GPA for semester of readmission
Qual. Pts. ______ GPA ______ Classification______
___ Must repeat courses: ____________________________
Holds? _____ No _____ Yes, as follows
___Must submit mid-term progress report to dean/director
___ Library
___Contingent upon _____________________________________________________________________________
___ Graduate Office
___ Dean of Students ___ Business and Finance ___Parking
VLP ____________________ Date __________
___ Other ______________________________________________________________________________________
Dean’s/Director’s Signature ________________________________________________
Original — Registrar
Yellow Copy — Student
Date ______________________
Pink Copy — Admissions
Revised February 2017
— Office of the Registrar — Application for Undergraduate Readmission FORM — Page
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