Fort Valley State University Office of the Registrar Office of the Registrar \ A State and Land-Grant University University System of Georgia 1005 State University Drive - Fort Valley, Georgia 31030-4313 APPLICATION FOR RE-ADMISSION Read carefully prior to completing each item Print all items completely and accurately Sign and date the completed form Note: To ensure adequate processing time for regular enrollment activities, this form must be submitted to the Office of the Registrar 20 days prior to the start of the term I wish to re-activate my files for: Year: _ □ Ms □ Mrs □ Mr □ Summer □ Fall E-mail address: Last First ID#: _- _- _ Telephone: ( _ Home Address: _ City: _ County of Residence: Zip: _ Gender: □ Male Widow □ Spring □ Female Marital Status: Mi ) State: □ Single □ Married □ Divorced □ Race: _ Date of Birth: _ / / _ Month Date Year How long have you maintained legal residence in Georgia? Years Are you a veteran? □ Yes □ No Previous enrollment at FVSU: Term: _ Year: _ What is your intended major? _ Have you attended another accredited college/university since your last attendance at FVSU? If yes, please complete information below: 478.825.6282 ▪ Fax 478.825.6155 An Equal Opportunity, Affirmative Action Institution College/University Location Dates Attended Note: Failure to provide information concerning other collegiate enrollment(s) will provide grounds for immediate dismissal Official transcripts are required from each institution attended Transcripts must be received prior to processing this form I certify that the information provided is accurate and complete Signature: _ Date: Revised: August 1, 2007 478.825.6282 ▪ Fax 478.825.6155 An Equal Opportunity, Affirmative Action Institution