Re-Admit Application

Undergraduate Re-Admit

For additional assistance, please contact us at the following:
The Office of Admission
Phone: 209.946.2211
E-mail: admission@pacific.edu

Name and Contact Information

Pacific Student ID # (required for re-admission)

First Name

Preferred First Name (if different)

Last Name

Middle Name

Do you have a former name on academic records?

Yes

Former First Name

Former Middle Name

Former Last Name

College Information

Name of college where you are currently enrolled or last attended

Level of Study

Entry Date

Are you currently still attending?

Yes

Last Date of Attendance

What was your GPA at this school?

Will you have completed a degree from this institution prior to entry to the University?

Yes

What type of degree?

Add Another Institution

Institution Name

Level of Study

Entry Date

Last Date of Attendance

What was your GPA at this school?

Will you have completed a degree from this institution prior to entry to the University?

Yes

What type of degree?

Add Another Institution

Institution Name

Level of Study

Entry Date

Last Date of Attendance

What was your GPA at this school?

Will you have completed a degree from this institution prior to entry to the University?

Yes

What type of degree?

Statement of Interest

Please summarize your activities since you were last enrolled at Pacific.
Optional

Why did you leave Pacific and what prompts you to return?

Other Details

Have you been convicted of a felony in the last 5 years?

Yes

Since you left Pacific have you been dismissed, suspended, or placed on probation by any college or university?

Yes

Disclosure

I certify that the information on this application is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment or any appropriate disciplinary action. I authorize the University to verify the information I have provided with all the schools I have attended. I agree to notify the proper officials of the institution of any changes in the information provided. I grant all schools I have attended permission to release my transcript(s) to University of the Pacific.

Signature