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Application for Re-Enrollment

Office of Undergraduate Admissions


This form should be completed using the latest version of Adobe Reader,
which you can download here for free. After the form is complete, please
print, sign, and submit it to the Office of Undergraduate Admissions.

Term Re-Applying for: ______________


Semester

Year

_________________________________________________________________
First Name

Middle Initial

Last Name

___________________

Maiden Name (if applicable)

_________________________________________________________________
Address: Number & Street

APU ID Number (###-##-####)

___________________

Apartment/Unit

_________________________________________________________________
Address: City

State/Province

Postal Code

Date of Birth (mm/dd/yyyy)

___________________

Country

Social Security # (###-##-####)

_________________________________________________________________
Home Phone

Preferred?

Cell Phone

Email Address

Preferred?

Do you plan to
enroll as a full-time student?
live on campus?
apply for financial aid?

Yes
Yes
Yes

No
No
No

Church Information

Gender:

Citizenship:

Male
Female

US Citizen
Permanent US Resident
Non-US Citizen

Name: _____________________________________________

Do you have a personal relationship with Jesus Christ?


Yes
No

City: ______________________________________________

How often do you attend church related activities?

State/Province: ______________________________________

More than once weekly

Weekly

Denomination: ______________________________________

Monthly

Rarely

Azusa Pacific University is an institution built on Four Cornerstones, which define why APU exists:
Christ (God First since 1899!)
Transformational Scholarship (strong academic programs that develop your character and prepare you for your future)
Life-giving Community (a campus environment that encourages involvement and dynamic relationships)
Sacrificial Service (a culture of serving others and giving of yourself)

Are you readily willing to embrace these Four Cornerstones as you consider the educational, social, and spiritual
environment at Azusa Pacific University?
Definitely
Unsure (Please contact me for details)
Not at this point
Have you ever been found guilty, or responsible for,
any criminal or military offense, excluding minor
traffic violations, either as a juvenile or an adult?
Yes

No

(If yes, please explain

Attach separate sheet if necessary

Have you ever been academically dismissed from,


declared ineligible to attend, or incurred disciplinary
action at any institution?
Yes

No

(If yes, please explain

Attach separate sheet if necessary

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Application for Re-Enrollment


Office of Undergraduate Admissions
Previous Education Information: In the space below, please provide the requested information for ALL colleges &
you have taken courses at more than 6 institutions, please provide the
universities attended, both before and after attending Azusa Pacific University. (ifrequested
information for each additional institution on a separate page)

_____________________________________________
College Name

From

_____________________________________________
College Name

College Name

College Name

College Name

(mm/yyyy)

______________

To (mm/yyyy)

Credits Completed

(mm/yyyy)

______________

To (mm/yyyy)

Credits Completed

(mm/yyyy)

______________

To (mm/yyyy)

Credits Completed

_____________________
From

_____________________________________________

Credits Completed

_____________________
From

_____________________________________________

______________

To (mm/yyyy)

_____________________
From

_____________________________________________

(mm/yyyy)

_____________________
From

_____________________________________________

College Name

_____________________

(mm/yyyy)

______________

To (mm/yyyy)

Credits Completed

_____________________
From

(mm/yyyy)

______________

To (mm/yyyy)

Credits Completed

Please indicate the academic major you plan to study at APU: ________________________________________________

Please sign below, indicating that you understand and agree to the following:
Re-enrolling is an application process and I must be re-admitted to the university before I may enroll in classes.
I must have a zero balance on my APU account and have no defaulted loans before I can be re-admitted.
I understand that if I have been away for more than two semesters I will be subject to new catalog requirements.
If I have attended any other schools in my time away from Azusa Pacific University, I must submit official transcripts
from each school attended.
I must receive clearance from the offices of Student Life, Student Financial Services, and Residence Life. The Office of
Undergraduate Admissions will contact these offices for clearances on my behalf.
I understand that if I have filed an Intent to Graduate form and have been away from Azusa Pacific University for more
than two years, I am no longer under the same catalog and therefore, may need additional requirements to complete my
degree.
Upon re-admission to the university, my academic record will be evaluated by the Office of the Undergraduate
Registrar in order to determine the remaining units/requirements needed to fulfill degree requirements.
I certify that the information in my application is complete and correct to the best of my knowledge. If my application
is accepted, I agree to abide by the policies, standards, and regulations at Azusa Pacific University and respect the
ideals, principles, and traditions it upholds as a Christian institution of higher learning. I further understand that this
information will be relied upon by the officials of the university in determining my admission status and that the
submission of false information is grounds for rejection of my application, withdrawal of an offer of acceptance,
dismissal from the university, revocation of a degree, and/or other disciplinary action.

_________________________________________________________________

___________________

Signature

Date

Office of Undergraduate Admissions Azusa Pacific University PO Box 7000 Azusa, CA 91702
Phone: (626) 812-3016 Fax: (626) 812-3096 Email: admissions@apu.edu

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