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Records Office ♦ 3835 Green Pond Road ♦ Bethlehem, PA 18020 ♦ Fax: 610-861-5551

RE-ADMIT FORM
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 #:                 Birth date:

Last Name:  First Name:   Middle Initial:

Prior Name:
Note: Name changes require a marriage certificate, court order or divorce decree showing the change.


Primary Phone #:

Alternate Phone #:   Extension:

(No P.O. Box only, must provide street location)

Permanent Address:

                      City:     State:     ZipCode:
                        

Mailing Address:    

                City:     State:     ZipCode:

County of Residence:     Resident School District:

Changing your permanent address may affect your Residency status.  Review the Residency Policy:
       
http://www.northampton.edu/Student-Resources/Bursar/Policies/Residency-Policies.htm


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? Yes    No

    Select Race(s); check one or more: American Indian or Alaska Native
Black or African American
Asian
Native Hawaiian or other Pacific Islander
White


Re-Admit semester:         Re-Admit year:

Intended Program/Major upon return:

Semester last attended:         Last attended year:

            I applied previously, but never attended  Yes  No

            Program/Major during last attendance:

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 other college/university:
        *For 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 college/university:   

                 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.

    Yes   No

 

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