Submit an Application for Re-Enrollment

Re-Enrollment Application

Name and Citizenship

Non-US citizens not providing a visa type will experience processing delays.

Email Address*

First Name*

Middle Name

Last Name*

Date of Birth (mm/dd/yyyy)


Month	Day	Year

ID Number

Previous Name

Country of Citizenship*

Visa Type (if non-US citizen)

Are you eligible for Veterans Benefits?

If you answered yes, please access the Financial Aid/Veterans Affairs web site http://www.units.muohio.edu/sfa/veterans/

Have you ever been convicted of a criminal offense other than a minor traffic violation, or are such charges currently pending against you at this time?*

If you answer YES to the question above, you must submit a complete statement of explanation. (Fax number for your chosen campus will appear on the following page.)

Have you ever been dismissed, suspended, or placed on probation for NONACADEMIC reason by any secondary high school, college or university (including suspension or dismissal under Ohio Rev. Code 3345.22 and .23, commonly called House bill 1219)?*

If you answer YES to the question above, you must submit a complete statement of explanation. (Fax number for your chosen campus will appear on the following page.)

Permanent Home Address

Street Line 1*
Street Line 2
City*
State/Province
Zip/Postal Code*
Phone Number*	ex: +1 513 555 1234
Are you an Ohio Resident?*
Have you lived in Ohio for the previous 12 consecutive months?*	If you have not lived in Ohio for the preceding 12 consecutive months but qualify for residency according to Ohio code, submit an application at http://www.muohio.edu/registrar with all required documents for review to the Residency Officer at Miami.

Local Address

This section can be left blank if you have only one address and entered it above.
Street Line 1
Street Line 2
City
State/Province
Zip/Postal Code
Phone Number	ex: +1 513 555 1234

Academic Information

Re-entry Semester*
Year*	ex: 2099
Level
Program
Campus You Plan to Attend*

* indicates required field