Readmission Update Form

Readmission Update Form
Note: A new application is required if you completed your program and wish to take additional courses or change programs.
Name:*

First NameLast Name
ETSU E-mail Address:*
example@etsu.edu
E-number:*
Phone Number:

Area CodePhone Number
Note: If your name or address has changed since you were last enrolled at ETSU, you will need to request a name or address change: https://www.etsu.edu/advancementservices/update.php
Has your mailing address changed since you were last enrolled?*

YesNo
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For the past twelve months have you continuously resided in Tennessee?*

YesNo
Year for which you are requesting readmission:*
Semester for which you are requesting readmission:*
CLASSIFICATION (Check only one):

Master'sDoctorateCertificate ProgramGraduate Non-degree (Holds Bachelor’s or higher degree and is not working toward a graduate degree)Education Specialist (EDS)
ETSU Major (Program Enrolled):*
Concentration (If Applicable):
Have you attended any other College or University since you were last enrolled at ETSU?*

YesNo
If Yes, Name of School:
Are you currently enrolled at this school?*

YesNo
Are you a Veteran? *

YesNo
Have you ever been convicted of a felony?*

YesNo
Are you requesting readmission following an approved Leave of Absence?

YesNo
Leave of Absence documentation:

Browse Files

Cancelof
Graduate Coordinator Information

Find the Graduate Coordinator's email here.
Coordinator's Email:*
example@etsu.edu
I certify that all the above statements are correct and complete.
Student's Signature*

Clear
EMAIL ADDRESS LISTED MUST BE YOUR ETSU EMAIL.
Please correct to submit the form.
Coordinator's Section
Coordinator's Approval*

YesNo
Date

MonthDayYear
Date
Explanation (For office use only)*
Coordinator's Signature:

Clear
1,2,3
Should be Empty:

Readmission Update Form

Coordinator's Section