Undergraduate Application for Readmission

Personal Information

Prefix

First Name

Preferred First Name

Middle Name

Last Name

Former / Other Last Name

Suffix

Birthdate

Mobile Phone

Country

Street

City

Region

Postal Code

Citizenship

Are you a legal resident of South Carolina?

Yes

Social Security Number
Please use the following format: XXX-XX-XXXX

What was your Banner ID#?

Academic Intent Details

Entry Term

Program

Previous Attendance and Other Colleges

Term you last attended South Carolina State University

Have you attended any colleges or universities since you were last enrolled at South Carolina State University?

Yes

List below, all the colleges or universities you have attended since you last enrolled at South Carolina State University.

Delete_ID_
College / University
Name CEEB (Hidden) Level of Study From From To To Degree

Add College / University

Did you officially withdraw?

Yes

Term You Withdrew

I hereby certify that the information given is true to the best of my knowledge. I agree to meet all obligations, financial and otherwise, as set forth in the University's literature. I understand that readmission to continue my academic studies does not approve my financial aid.

Signature

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