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
colleges/universities to the
NCC Admissions Office 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:
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.