Application for Undergraduate Reenrollment
This form is for use by students who have previously attended Kent State University as an
undergraduate student, and would like to return as an undergraduate student.
Reenrollment Term _______Year________
I. Reenrollment Eligibility
YES 
NO 
Did you previously attend Kent State as an undergraduate student?
If the answer to this question is “no” you cannot complete this form for reenrollment, contact the
Admissions Office to apply to the university: http://www.kent.edu/admissions/undergraduate/index.cfm
YES 
NO 
Were you dismissed from Kent State during your last attendance?
If the answer to this question is “yes”, you cannot complete this form for reenrollment, you must
complete a Request for Undergraduate Reinstatement.
http://www.kent.edu/undergradstudies/advisingcenter/reinstatement-to-the-university.cfm
YES 
NO 
Have you attended any other higher education institution since you attended Kent State?
If the answer to this question is “yes” you cannot complete this form for reenrollment, contact the
Admissions Office to apply to the university: http://www.kent.edu/admissions/undergraduate/index.cfm
YES 
NO 
Were you a transient or post-secondary option student during your last period of attendance?
If the answer to this question is “yes” you cannot complete this form for reenrollment, contact the
Admissions Office to apply to the university: http://www.kent.edu/admissions/undergraduate/index.cfm
II. Personal Information (Please print)
Complete Legal Name: (Last, First, Middle or Initial)
Former Name(s):
(This reenrollment will be processed under your legal name at the time of last attendance.)
Kent State ID Number (if known) or SSN
Permanent Address:
City:
Telephone Number:
State:
Email Address:
Zip:
Gender:
 Male  Female
County:
Date of Birth: MM/DD/YYYY
US Citizen:  Yes  No
If no, please provide documentation of immigration status to the Office of Global Education.
If no, are you a US Permanent Resident, refugee or on political asylum in the United States:  Yes
If yes, please provide documentation of legal status to the Office of Global Education.
Ethnic Origin: The following information is used for reporting purposes only.
What is your ethnicity?
 Hispanic or Latino
 No
 Not Hispanic or Latino
Select one or more race(s) to indicate what you consider yourself.
 White
 Asian
 Black or African American  American Indian or Alaska Native
 Native Hawaiian or Other Pacific Islander
III. Residency Information – Note: This form will not be processed without residency information.
How long have you lived at the above address?
If less than one year, list previous address(es) during the last twelve months.
IV. University Information
Last term and year of attendance:
How long at this address?
List KSU campus(es) attended:
 Ashtabula
 East Liverpool
 Geauga
 Kent
 Salem
 Stark
 Trumbull
 Tuscarawas
V. Educational Intention
Do you intend to pursue your degree 100% online?
 Yes
 No
Please check only one from the following:
No KSU degree awarded  Continue my prior degree program.
 Take classes for enrichment purposes. (You will be reenrolled as a non-degree student.)
 Pursue a new degree program. (You will be reenrolled into your prior program and should contact your college
for information on changing to a new degree program.)
KSU degree awarded  Bachelor’s degree was awarded
 Take classes for enrichment purposes or pursue a new degree program. (You will be reenrolled as a nondegree student. You must contact your college office if you wish to pursue a new degree program.)
 Associate’s degree was awarded
 Take classes for enrichment purposes or pursue a new degree program. (You will be reenrolled as a nondegree student. You must contact your college office if you wish to pursue a new degree program.)
VI. Veteran Information
Are you a Veteran?  Yes
 No
If yes, was your absence due to Military Service, either voluntary or involuntary?  Yes
 No
*If the answer to both of the above is “yes”, contact your VA certifying official at your campus.
VII. Conviction Information
Have you ever been convicted of a criminal offense or have charges pending against you at this time, other than a minor
traffic violation?
 Yes  No
Have you ever been dismissed, suspended or placed on probation by any other higher education institution for a nonacademic reason?
 Yes  No
If the answer to either of the above is yes, a Personal Explanation Statement must be submitted. This form can be
found at www.kent.edu/registrar/forms. This reenrollment will not be processed until the statement is received and
reviewed to determine your eligibility for reenrollment at Kent State University.
I certify that the information herein is complete and accurate to the best of my knowledge.
Print Form and Sign - Handwritten Signature Required
Student Signature: _____________________________________________
Date: ____________________
This Application for Undergraduate Reenrollment form can be submitted to the Office of the University Registrar in one of the
following ways:
Bring To: Office of the University Registrar Service Counter, Room 108, Schwartz Center
Mail To: Kent State University, Office of the University Registrar, P.O. Box 5190, Kent, OH 44242-0001
Fax To: (330) 672-4836
Scan and Email To: recrdsvc@kent.edu
Office Use Only:
Processed by: ___________________________ Holds Verified: ________________________ Date: ________________________