Application for Readmission

Name:*

First NameMiddle or MaidenLast Name

Name while at Muskingum:

First NameMiddle or MaidenLast Name

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone:

Area CodePhone Number

Cell Phone:

Area CodePhone Number

Email:*

example@example.com

Proposed re-entrance term:*

Fall SemesterSpring SemesterMay/Summer

Year of re-entrance:*

ex: 2019

Dates of attendance at Muskingum:*

ex: MM/DD/YY to MM/DD/YY

Reason for leaving Muskingum:*

List any college attended since leaving Muskingum. Please arrange to have an official transcript of additional course work mailed directly to the Admission Office. Student-issued copies are not accepted.

Institution:

Dates of attendance:

ex: MM/DD/YY to MM/DD/YY

Institution:

Dates of attendance:

ex: MM/DD/YY to MM/DD/YY

List of work experience or major activities since leaving:

Were you in good academic standing at time of departure from Muskingum University?*

YesNo

If no, please upload a statement giving reasons why Muskingum should consider your application for readmission.

Browse Files

Please use a DOC or PDF file.

Do you plan to apply for financial aid?

YesNo

Residence Status:*

live on campus.commute to campus

Do you plan to participate in the PLUS Program for students with learning differences?

YesNo

What is your intended academic major?:

Signature:*

Please type your full name above as a confirmation that all the information listed on this form is correct to the best of your knowledge.

Muskingum University does not discriminate in its employment or educational programs or activities based on age, ancestry, color, disability, genetic information, gender identity or expression, military or veteran status, national origin, political affiliation, pregnancy, race, religion, sex, sexual orientation, or socioeconomic status.The following people have been designated to receive inquiries and reports of discrimination and to coordinate the University’s response.

Lindsay Carr
Executive Director of Disability Resources Services
Walter Hall – 24
740-826-8284
Disability discrimination

Holly Gleason
Assistant Vice President for Human Relations and Risk Management
Montgomery Hall – 16C
740-826-8116
Age discrimination

Inquiries may also be directed to the U.S. Department of Education, Office for Civil Rights, 1350 Euclid Avenue, Suite 325, Cleveland, OH 44115-1812, 1-800-877-8339 or OCR.Cleveland@ed.gov