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Department of Sociology

Graduate Application for Re-Enrollment

This application must be completed if you have not been enrolled in a graduate-level course at Messiah College within the past two semesters. If it has been more than two years since you last enrolled in a course, you must complete the full graduate application for the program in which you desire to participate.

 

Personal Data

Title:
First Name:* Middle Name:
Last Name:* Student Identification Number
(if known):
Mailing Address:*
City:* State:* Zip*:  
Home Phone:*  
Mobile Phone:  
Work Phone:  
Preferred Contact Number: Home Mobile Work
Preferred Email Address:*
 

Have you been convicted of a felony or misdemeanor since the date of your original application for admission to Messiah College?*

Yes No
If yes, explain fully:
Were you subject to any academic or disciplinary sanctions, or were any academic or disciplinary proceedings pending, at the time of your withdrawal from Messiah College?
Yes No
If yes, explain fully:

Additional Information:

When was the last time you were enrolled at Messiah College? Year:
For which program are you seeking re-enrollment?
Are you seeking re-enrollment as a:
degree seeking student non-degree seeking student?
When do you wish to re-enter Messiah College? Year:
           
           

Reason for Termination

Describe why you terminated your studies at Messiah College and why you wish to return at this time.
(max 250 words)

Since terminating your studies at Messiah College, have you completed coursework at another college or university?
Yes No
If yes, please forward an offcial transcript to Graduate Programs, Messiah College, 1 College Ave, Box 3060, Mechanicsburg, PA 17055 or email to GradPrograms@messiah.edu.
 

Statement and Signature

I certify that I am familiar with the standards and expectations for graduate student conduct at Messiah
College as summarized in the Graduate Programs Handbook. If re-admitted as a student, I agree to
abide by these guidelines. I also certify that the information I have provided on this application is
complete and accurate.

 

Name:*
Signature:*
I have read the foregoing statement and acknowledge that checking
this box electronically serves the same purpose as affixing my
original signature to this document.

 

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