CINCINNATI BRANCH

Application for Re-Admission

Please type or print clearly in ink. No application fee is required.

To which campus are you applying?(check one) / Blue Ash Cincinnati State
PERSONAL DATA
Name
Last / First / Middle
Maiden Name
Address
Street
City / State / Zip / Country / County
E-mail / Birth Date
mm/dd/yyyy
Telephone / () / ()
Home / Cell
Social Security Number / - - / State of Legal Residence / U.S. Citizen? / YesNo
Employer / Telephone / ()
Company Name / Position / Work
Name and address under which you were previously enrolled (if different from above)
ADDITIONAL PERSONAL INFORMATION*
*wilmington college uses this information for statistical purposes only.
Gender: / Male Female
Marital Status: / Single Married Divorced Widowed
Are you Hispanic/Latino? / Yes No
How would you describe yourself?
American Indian or Alaska Native / Asian / Black or African American
Native Hawaiian or other Pacific Islander / Non-Resident Alien / Two or More Races / White
ENROLLMENT INFORMATION
Re-Applying for Semester beginning 20 / (check one) / Fall Spring Summer
Date you last attended Wilmington College:
ACADEMIC INTERESTS
Primary academic major interest:
Accounting / Multimedia Studies (Cincinnati State Only)
Business Administration concentrating in:(check one below) / Liberal Studies
Management / Strategic Organizational Leadership
Finance / Strategic Human Resources Management
Business Analysis (Cincinnati State Only)
EDUCATIONAL DATA
List all other colleges, universities or post-secondary institutionsin which you have been enrolled since you last attended Wilmington College, including non-U.S. institutions, beginning with the most recent.
Name and Location of Institution* / Dates of Attendance
(month and year) / Reason for Withdrawal / Total # of Credit Hours Completed / G.P.A.
*An official college transcript from each institution is required to complete your readmission file.
Are you applying for Fresh Start Program? (check one) / YesNo
A person is eligible for the Fresh Start option after five (5) consecutive calendar years of absence from Wilmington College. A Fresh Start will be granted upon readmission if requested by the applicant on this form. Upon readmission under Fresh Start, course work begins with no cumulative grade point average. Previous Wilmington College courses with grades of C or above will fulfill requirements for a degree, but the quality points will not be computed with the GPA. Readmission under Fresh Start places a person in good academic standing. A Fresh Start participant may earn baccalaureate honors. Fresh Start may be used only once.
All previous outstanding accounts with the College must be cleared before you can be considered for readmission. Please indicate the currentstatus of your account at the Student Financial Services(check one):
Clear Owe Amount Owed: / $
Please explain your reasons for leaving Wilmington College:
Please tell us why you wish to return to Wilmington College:
ADDITIONAL INFORMATION
Are you applying for financial aid at Wilmington College? / Yes No
Are you eligible to receive benefits through any of the Veterans Administration Programs? / Yes No
Are you eligible for tuition benefits from Wilmington College or your employer? / Yes No
Have you ever been convicted of a felony or are any currently pending? / Yes No
We will contact you on a regular basis regarding readmission and financial aid matters. Please check below the method(s) in which you prefer to be contacted.
Home Telephone Cell Phone Work Telephone E-mail Address
Check here if you are open to being contacted by WC via text messaging. (Standard messaging charges may apply.)
Please read the statements below and check the boxes.
I certify that the information on this application for readmission 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 College 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 understand that readmission to Wilmington College is based on academic performance as well as social conduct and personal reputation. The College reserves the right to deny my application, withdraw any offer of acceptance or cancel enrollment should knowledge of any social misconduct be learned during the re-admission process or once I have re-enrolled at the College.
SIGNATURE OF APPLICANT / required
I certify that the information on this form is true and that any purposeful misrepresentation may result in denial of readmission or dismissal from Wilmington College.
Signature (Required) / Date
If you would like to note any factors not previously mentioned that would support your Application for Re-Admission, please attach an additional sheet.
Submit application to the campus you plan to attend:
BLUE ASH BRANCH / CINCINNATI STATE
9987 Carver Road, Suite 100• Blue Ash, OH 45242 / 3520 Central Parkway, Room 330 BTD • Cincinnati, OH 45223
PHONE (513) 793-1337 • FAX (513) 793-1346 / PHONE(513) 569-1806 • FAX (513) 569-1467
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For more information, go to
Wilmington College does not discriminate on the basis of age, race, color, religion, national or ethnic origin, gender, sexual orientation, or disability in the administration of education policies, admission policies, financial aid, employment or any other college program or activity. Also, in compliance with federal law, the College has prepared annual Campus Safety and Security reports. These reports include a description of the following: Wilmington's Campus Safety services; crime prevention; on-campus housing policies; community member responsibilities; summaries of policies regarding alcohol, illegal drugs, sexual offenses and weapons; and crime statistics for the previous academic year. A copy of the current report can be obtained by contacting Office of Admission
08/2016

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