ADMISSIONS
REQUEST INFORMATION FOR RE-ADMISSION
 
PERSONAL INFORMATION
First Name :
Middle Name :
Last Name :
Maiden Name (if applicable) :
Home Phone :
( ) -
Business Phone :
( ) -
E-mail Address :
Social Security Number (if applicable) :
Birth Date (month/day/year) : / /
Sex :
ADDRESS & MAILING INFORMATION
Street Address :
City :
State :
Zip :
Country :
ENROLLMENT INFORMATION
Re-admission requested for : /
Intended status upon re-admission : Student
Last enrolled at S-TU or SIU (month/year) : /
Applying for :   if other explain:
Housing Status :
Intended Major :
Why did you leave Salem International University :
List all Colleges/Universities Attended (Most Recent First) :
College/University Name :
City :
State :
   Zip :
Dates Attended :
College/University Name :
City :
State :
   Zip :
Dates Attended :
College/University Name :
City :
State :
   Zip :
Dates Attended :
Where you eligible to return to the college you last attended?    
If "no" explain :
FINANCIAL AID INFORMATION
Financial Assistance Required :
Qualified for Financial Assistance at last college attended/attending :
Status of the Financial Aid Form:
Correct copy on file at most recent college attended/ing :
New FAF sent to Iowa City, IA with Salem International University listed as one of the intended colleges/universities :
The new FAF was mailed (month/day/year) :

I hereby certify that the information contained in this application is complete and accurate to the best of my knowledge. I will, if re-admitted, reacquaint myself with and abide by the Student Code of Conduct and other requirements governing the academic and social standards of Salem International University.

Agreed:         Date: (month/day/year)