Application for Readmission

(For best results, please fill out this form using the Google Chrome Browser.)

Student Information

Social Security Number *

Full Legal Name (include first, middle, and last name) *

list any other former last names used (maiden name, etc.)

Email Address (to receive a copy of this form) *

When do you plan to enroll? *

of what year? *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

Are you a U.S. citizen? *

If no, list country of citizenship.

Do you have a resident-alien card?

If U.S. Citizen, list home (resident) state *

How long have you been a resident of your home state? Please indicate years, months, etc. *

Are you on full-time active military duty? (includes spouses and dependent children) *

Highest Degree of Certificate Earned *

Immediate Educational Goal *

Semester last attended at Northwestern (semester/year) *

In the area below, list ALL college attended SINCE leaving NWOSU (if NONE, please indicate). Include the name and address of the College or University, as well as the dates of attendance. *

Current Date *

Terms & Conditions

STATEMENT OF APPLICANT: I certify that I am in good academic standing (eligible for re-admission at the last institution attended) and that I understand that I must provide the Registrar at Northwestern Oklahoma State University with official transcripts from all schools attended since leaving this university. I understand that I may be expelled from the university for withholding or falsifying records or information concerning my enrollment in other schools. I state under penalty of perjury under the laws of Oklahoma that the facts stated on this readmission application are true and complete to the best of my knowledge.

Check this box as your electronic signature.