Western Illinois Universityschool of Graduate Studies

Western Illinois University Request to Reactivate Application School of Graduate Studies

This form is to be completed by those students who have applied to the Graduate School within the last two years but did not attend. If you applied more than two years ago, you should complete the application for new students.

Name (Last, First, MI/Previous):

Social Security No: WIU ID No.: Permanent address: Permanent phone: Current address: Current phone: Current address is valid until: Cell phone: Applying for (select one): __Fall __Spring __Summer 20____ Email address: Applying as degree-seeking student for the degree in:

Primary attendance location: ___Macomb ___Quad Cities ___Other

If you are applying as a degree-seeking student, OFFICIAL transcripts of any course work completed since last applying to WIU should be submitted to the Graduate School. OR Applying as nondegree student (please choose one of the following):

___Nondegree student pursuing Educational Leadership ACI (Alternative Certification Initiative) ___Nondegree student enrolling in classes not pursuing degree or certification ___Nondegree student pursuing additional course work for recertification ___Nondegree student pursuing additional course work for teaching endorsement ___Nondegree student pursuing INITIAL teacher certification ___Nondegree student pursuing a second bachelor’s degree in (specify degree): ___Nondegree student pursuing a post-baccalaureate certificate in (specify certificate):

If you are applying for a different graduate degree major than that on your previous application and already have a personal goals statement and letters of recommendation on file, do you want those documents to be used for admission to the new program:

___Not applicable, I am not applying for a different degree program. ___Yes, please use all the former documents for the new program major. ___No, I will be submitting both new personal goals statement and letters of recommendation. ___No, please send the former letters of recommendation but I will submit a new personal goals statement. ___No, please send the former goals statement but I will submit new letters of recommendation.

List all colleges or universities attended since LAST applying to WIU:

I understand that withholding information requested on this application or giving false information may make me ineligible for admission to the University or subject to dismissal. I certify that the statements I have made on this application are correct and complete.

Signature: ______Date: ______

Western Illinois University School of Graduate Studies 1 University Circle Form will not be processed without a signature. Macomb, IL USA 61455-1390 Phone (309)298-1806; Fax (309)298-2345 Mail completed form to the School of Graduate Studies. www.wiu.edu/grad; Email: [email protected] 8-26-11