South Dakota Public Higher Education
Undergraduate Student Readmission Form

Purpose: This form is intended for use by students who have attended a South Dakota Regental University, discontinued their enrollment and now seek to be readmitted. Information in addition to what is requested on this form may be required to properly evaluate the readmission request.

Legal Name

Last Name: First Name:
Former Name:
Preferred First Name:
Social Security Number:

Permanent Mail Address

Street:
City: State:

Zip Code:

Telephone: E-mail:

Emergency Contact

Name:

Relationship to you:

Street:
City:

State: 

Zip Code:

Telephone:

Residency

Have you lived in South Dakota for the past 12 months? Yes   No 

If you are a South Dakota resident, but you have not lived in South Dakota for the past 12 months, please explain:


Select your home university (the university from which you will obtain your degree):

BHSU    DSU    NSU    SDSM&T    SDSU    USD

Prior Enrollment:
When/Where did you last take classes from a South Dakota public university?

Semester and year you wish to reenroll:  Fall    Spring    Summer     Year


Educational Goal:
Will you be pursuing a degree? Yes   No
If yes, what degree?
If no, you are not seeking a degree and understand that you will not qualify to receive federal financial aid.

Are you an SDSU coop student?   Yes      No
If yes, select one of the three options below: 
Option #1 (Certification Only}
Option #2 (An ELED degree)
Option #3 (An ELED/SPED degree)


Post Secondary Education
List in chronological order all post-secondary institutions you attended after you discontinued enrollment in the South Dakota public university system regardless of length of attendance and even if no work was completed. Failure to list all institutions previously attended may result in loss of credit and/or dismissal.

Name of Institution:      
Location (City/State):   
From Month/Year:         To Month/Year:

Name of Institution:      
Location (City/State):   
From Month/Year:         To Month/Year:

Name of Institution:      
Location (City/State):   
From Month/Year:         To Month/Year:

If you are transferring from another institution, are you eligible to return? Yes   No
If no, why?

All answers I have given on this form are complete and accurate to the best of my knowledge. I understand that a readmission decision will be based on the information provided herein and other relevant academic and administrative information.