Records Office ♦ 3835 Green Pond Road ♦
Bethlehem, PA 18020 ♦ Fax: 610-861-5551
To be used by students who did not attend for one or more major semesters or who previously applied but never attended.
Student ID# or last 4-digits of Social Security #:
Last Name: First Name:
Note: Name changes require a marriage certificate, court order or divorce
decree showing the change.
Primary Phone #:
Alternate Phone #:
(No P.O. Box only, must provide street location)
County of Residence:
Resident School District:
Changing your permanent address may affect
your Residency status. Review the Residency Policy:
The following is used for the sole
purpose of providing statistical data to the Federal Government. This
information is not used for Admissions/Re-entry purposes.
Are you Hispanic?
Re-Admit semester: Re-Admit year:
Intended Program/Major upon return:
Semester last attended:
Last attended year:
I applied previously, but never attended
Have you ever received a degree, certificate, or specialized
diploma from NCC?
Have you attended any other college/university since your
last attendance at NCC?
If yes, list
transfer credits to be evaluated, submit official transcripts from all other
firstname.lastname@example.org and complete a "Request
for Transfer Credit Evaulation" form.
Have you graduated from any other college/university since
your last attendance at NCC?
If yes, indicate
Indicate degrees received:
Processing Note: A student who did not indicate veteran or active duty status at the time of application may provide documentation (i.e. DD214 form) to the Office of Student Veterans Services to have the College database records updated.
By clicking YES, I certify that all information stated above is my valid,
personal information and that I wish to be re-admitted to Northampton Community College.