First Name

Last Name

Maiden Name

Northwestern ID or last 4 digits of SSN

Last year of attendance or graduation year

Do you still have access to theROCK?

YesNo

This e-mail address will be used to send your confidential UNW username and password upon re-enrollment.

Street Address

City

State

Zip Code

Phone Number

Date of Birth

Are you a U.S. Citizen?

For which year and term would you like to be re-admitted to Northwestern?

Please list any other colleges/universities you have attended since leaving Northwestern

Which academic program would you like to enter? Bachelor of ArtsBachelor of ScienceAssociate of Applied Arts and BibleAssociate of Applied Science and Bible

Choose your desired major and/or minor:

Desired Major (select below)

Desired Second Major (if applicable, select below)

Minor (If applicable)

Will you be living in student housing?

Would you like to be contacted about additional academic support services such as disability accommodations, peer coaching, advocacy, academic skills building and specialized tutoring sessions?

Contact me regarding academic support services.

YesNo

Do you have any additional comments or questions?

PLEASE READ BEFORE SUBMITTING. If I have any questions about
registration, financial aid, or admissions, it is my responsibility to contact
the respective office. It is my responsibility to contact the appropriate office(s)
to receive information about academic support prior to registering for classes
at University of Northwestern – St. Paul. Students may contact Academic Achievement at (651) 631-5292 or AcademicAchievement@unwsp.edu, or consult unwsp.edu/student-life/academic-success/disability-services regarding the American with Disabilities Act (ADA) or reasonable accommodation information. I understand if the last term I was enrolled was more than seven years ago, my graduation requirements may change from what they were when I started
the program. By submitting this form, I agree to live within the guidelines outlined in
the Declaration of Christian Community and those outlined in
the student handbook (Traditional Undergraduate Student Handbook).

I have read and agree to the above terms and conditions.

YesNo

Jan

21

Feb

18

Fleurish: Senior Design Exhibition

Jan

29

PSEO on Purpose

Living in Context

Rejoice Greatly

Undergraduate Re-enrollment Form