Graduate Returning Student Form

Personal Info

Name*

First Last

Middle Initial

Former Name

Address*

Street and/or PO Box City State / Province / Region ZIP / Postal Code Country

County

Gender*

Male
Female

Home Phone*

Cell Phone*

Date of Birth*

Email*

Are you a North Dakota resident?*

Yes
No

Length of residency*

State of residency*

Admission status when withdrew from VCSU

Term you plan to return to VCSU:

Fall Year

Spring Year

Summer Year

Please indicate intended education goal

Enter the number of graduate course(s)

Please read the following policy (# 6.3.c.):

No more than nine (9) credits taken under the non-degree status with a grade of B or higher can be transferred to any official program of study should there be, at any future date, a decision to seek degree classification.

Educational History

List in chronological order all colleges, universities, and other institution of higher education which you have attended or are attending.

College/University	State	Dates Attended	Major/Study	Degree	GPA	Actions

There are no Entries.

SIGNATURE*

By submitting this document, I certify that all statements in this returning student application are complete and true.

NOTE: This information is required for statistical purposes only and will not affect the status of your application. The information will not be used in a discriminatory manner and your response is voluntary.

Name

This field is for validation purposes and should be left unchanged.