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Request to Re-Activate the Undergraduate Application for Admission


*Indicates Required Field

*Reason for Re-activation Request
This form is used for the following situations only. Please check one:
I wish to re-activate the Undergraduate Admission Application for a new term.
I wish to re-activate my Baylor record because I have not attended Baylor since 1986. (If you have attended since 1986, your record is on file and you do not need to reapply. Contact the Registrar about re-enrolling.)
I wish to re-activate my Baylor record as a former provisional student so that I may return to Baylor.

Personal Information
Social Security Number:
Providing your social security number on this form is not required by a specific legal authority; however, it is important for purposes of maintaining the identity of your application, grade transcript and test scores.

Note: If you plan to apply for financial aid or work while enrolled, you are strongly encouraged to list your official social security number.
Legal Name
*Last:
*First:
Middle:
Preferred Name:
Former Name:
(What former name(s) might appear on your academic records?)
Permanent Address
*P.O. Box or Street:
*City:
State:
Zip: (if U.S.)
Country: (if not U.S.)
Home Phone: - -
Cell Phone: - -
*Date of Birth:
*Email Address:
Alternate Address
(If you are in school and have a phone number and mailing address that are different from the address and phone given above, please give a phone number and address where you can be reached.)
Date this address is no longer valid:
P.O. Box or Street:
City:
State:
Zip: (if U.S.)
Country: (if not U.S.)
*Have you ever been convicted of a felony or are you required to register your name and home address with any local or state law enforcement agency on the basis of a reportable conviction or adjudication?
No
Yes
If YES, please provide an explanation in the text box below.

*Country of Citizenship
United States
Country other than U.S.
Please specify your country of citizenship:
Are you a U.S. Permanent Resident?
No
Yes
If yes, please provide your Alien Registration Number:
Non-United States citizens including Permanent Residents must complete the Visa Authorization form.
What is your native language?
English
Language other than English
Please specify:
Are you bilingual?
No
Yes
Please specify:
Expected Enrollment Date
*Year:
*Semester:
Previously Applied
*Year:
*Semester:

Previous School Information
High School Information
*Complete High School Name:
City:
State:
Country: (if not U.S.)
Graduation/Diploma Date
*Month: *Year:
International Exams
Specify "0" levels, GCE, GCSE, SSEC or others:
College Information
List below the college(s) you have attended, are currently attending, or will attend in chronological order.
College 1
Name of College:
City:
State:
Country:
Attendance Dates
From: Month: Year:
To: Month: Year:
Degree Received:
Hours Completed:
Hours in Progress:
College 2
Name of College:
City:
State:
Country:
Attendance Dates
From: Month: Year:
To: Month: Year:
Degree Received:
Hours Completed:
Hours in Progress:
College 3
Name of College:
City:
State:
Country:
Attendance Dates
From: Month: Year:
To: Month: Year:
Degree Received:
Hours Completed:
Hours in Progress:

*Classification
New Freshman (no college credit)
New Freshman (with dual college credit)
Transfer with less than 24 semester hours
Transfer with more than 24 semester hours
Post-Baccalaureate
NonDegree
If Non-Degree, please specify:
Advanced Studies Program
Transient Student
Study Abroad Program
International Exchange Program (Include a letter from your current school giving approval for you to fill one of the places in their exchange agreement with Baylor.)
Other:
Readmission
(What was the last semester and year that you were enrolled at Baylor?)
Year:
Semester:

Program of Study
See www.baylor.edu/admissions/majors for available majors.
*Degree:
*Major:
Pre-Professional:
Applicants who intend to major in music must also apply for admission directly to the School of Music.
Are you also applying to start clinical nursing classes at Baylor's Louise Herrington School of Nursing Dallas?
No
Yes

Baylor Employee Information
If you are a dependent or spouse of a Baylor employee or are employed by Baylor yourself, please provide the following information:
Employee Name:
Department:
Relationship:

*Acknowledgement

I understand that the University, in maintaining the standards and ideals for which it stands, reserves the right to refuse admission to any applicant whose previous record is deemed unsatisfactory.

I certify that the information given on all forms of this application is true, correct and complete. I authorize the University to verify the information that I have provided and understand that the penalty for false, misrepresented, or omitted information may be revocation of admission or expulsion from the University. If accepted, I will agree to abide by the policies, rules, and regulations of the University.

Submit

Baylor University complies with all applicable federal and state nondiscrimination laws and does not engage in prohibited discrimination on the basis of race, color, nationality or ethnic origin, sex, age, or disability in employment or the provision of services.