
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.
Cell Phone #:
Alternate Phone #:
Extension:
I understand that Northampton Community College may use an automated calling system and a pre-recorded message to contact me by phone at any phone number I provide to the College.
(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://catalog.northampton.edu/residency-policy.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.
Gender:
Male
Female
Are you Hispanic?
Yes
No
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
transcripts@northampton.edu 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:
Are you a US Military Veteran*, Active Duty Service Member or Guradsman/Reservist? (*one who has been discharged/released from service under conditions other than dishonorable)
If yes, which branch?
Are you the spouse or dependent child of a US Military Veteran* or Active Duty Service Member? (*one who has been discharged/released from service under conditions other than dishonorable)
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.
Yes
No