This Form Is for Undergraduate Student Use Only. Students Who Have Not Been Enrolled At

Application for Readmission PO Box 4103 ∙ Flagstaff, Arizona 86011-4103 [email protected] Fax: 928-523-1414

This form is for undergraduate student use only. Students who have not been enrolled at Northern Arizona University for three consecutive terms (summer & winter terms excluded). Students who have not been out for more than three semesters, but have earned a bachelor’s degree and/or certificate from NAU should also complete this form. In order to begin a second bachelor’s program at NAU this form is needed. Note: If you were academically suspended from NAU, you must also submit a “Reinstatement Appeal Form” by the published deadlines through the Gateway Student Success Center. You can find the form on-line at: http://nau.edu/VPAA/University-Advising/Reinstatement/. For questions regarding the reinstatement appeal form, contact the Gateway at [email protected] or phone 928-523-4772. For assistance determining your enrollment history, and determining whether or not you have to apply for readmission, contact the Office of the Registrar at (928)523-2109.

Returning Term: ______Year: _____ Campus: ______Intended Major: ______

☐ Are you returning to NAU to have your degree posted, but do not plan on enrolling?

Student Information

Last Name: ______First Name: ______Birth Date: ______

Former Name: ______

E-Mail Address ______Dates Last Attended: ______

Address: ______Street City State Zip Phone: ______☐ Check here if you have no phone

Emergency Contact: Name: ______

Day Phone: ______Evening Phone: ______Cell: ______

Residency All applicants must complete this section. Your residency classification is your status as of the date of application. Failure to answer any question in this section will result in a classification of non-resident. (Put N/A if not applicable.) Additional verification and/or supporting documentation may be requested of the applicant if the answers to questions in the following section present an unclear and/or unconvincing representation of residency in the state of Arizona. Residency policies are subject to change without notice. Are you a U.S. Citizen? ☐ Yes ☐ No

If you are applying as an international student, please apply through our International Admissions site at: http://international.nau.edu/international_admissions/apply.html.

Please Note: In accordance with Arizona law, any person who is a citizen or legal resident of the US or who is lawfully present in the US may be eligible for specified financial aid from the university. Arizona law classifies any person who is a US citizen or who has lawful immigration status and is an Arizona resident as an in-state student for tuition purposes. Please visit www.nau.edu/registrar for more information. Do you consider yourself a resident of Arizona? ☐ Yes ☐ No

When did you start residing in Arizona (month and year)? : ______

Driver’s License: State: ______Number: ______Date Issued: ______

Do you own a motor vehicle? ☐ Yes ☐ No State Registered: ______Original Registration Date: ______

Are you entirely self-supporting? ☐ Yes ☐ No

If yes, do you file an Arizona income tax return as an Arizona resident? ☐ Yes ☐ No

If yes, when was the last filing year? ______If no, have you filed a tax return in a state other than Arizona? ☐ Yes ☐ No

If you are a dependent, are your parents or guardians residents of Arizona? ☐ Yes ☐ No Residency continued… Does either parent or your guardian file an Arizona income tax return as an Arizona resident? ☐ Yes ☐ No

Do your parents or guardians maintain a driver’s license or vehicle registration in a state other than Arizona? ☐ Yes ☐ No

Are you, either of your parents or spouse on active duty stationed outside of Arizona and claim Arizona residency? ☐ Yes ☐ No

Are you, either of your parents or spouse on active duty stationed in Arizona on military orders, or a member of the Arizona National

Guard, or a member of a Reserve unit based in Arizona? ☐ Yes ☐ No Have you been honorably discharged from the United States Armed Services? ☐ Yes ☐ No Please note: Effective the Fall 2011 term and terms following, students that have been honorably discharged from the U.S. Armed Forces and meet the conditions for in-state tuition as outlined in statute A.R.S. § 15-1802 will need to provide a copy of a DD-214 stating “Honorable Discharge”, and either of the following: proof of voter registration in the state of Arizona or a copy of an Arizona driver’s license to the Office of Military and Veteran Affairs by the start date of their readmission term. Send photo copies of the above documents to Northern Arizona University, P.O. Box 4117, Flagstaff, AZ 86011-4117, fax to (928)523-8387 or submit forms in person to the Student Veterans Center located in the Extended Campuses building 16A, Room 101. Please contact the Office of Military and Veteran Affairs at (928)523-VETS or [email protected] for more information. Are you an enrolled member of a Native American Indian Tribe of Arizona (that may also extend into another state)? ☐ Yes ☐ No

If yes, which tribe? ______Enrollment Card/Certificate of Indian Blood (CIB) number______

The reservation you reside on is located: ☐ 100% in Arizona ☐ Partially in Arizona

Armed Forces Affiliation Please select the one most appropriate answer regarding your United States Armed Forces Affiliation:

☐ Veteran

☐ Dependent of a veteran

☐ Active Duty

☐ National Guard or Reserves

☐ Dependent of Active Duty/National Guard or Reserves

☐ None of the above

☐ Decline to state

Academic Information List all colleges and universities attended since you were last enrolled at Northern Arizona University:

College/University Location Dates Attended Degree(s)

Please have the college(s) you attended send an official transcript of your academic record to the Office of Undergraduate Admissions and Orientation, Northern Arizona University, PO Box 4084, Flagstaff AZ 86011-4084.

I authorize the release of my academic records from NAU to a previously attended community college for the purposes of credit evaluation to determine my eligibility to receive an associate’s degree or other credential awarded by the community college. I understand that I have the right to rescind my consent any time at nau.edu/Registrar/Student-Resources/Reverse-Transfer, and that community college may not disclose my academic records to any other party without my permission. ☐ Yes ☐ No Please Read and Sign I understand that readmission granted on the basis of this application is void if the information given is not true and correct. I understand that readmission cannot be completed until all registration and financial holds are cleared. I agree to observe all the rules and regulations of Northern Arizona University. SIGNATURE OF APPLICANT: ______Date: ______