Tour Anderson University

Application for Re-activation

For students who have previously applied but never attended Anderson University.

*First Name:
Middle Name:
*Last Name:
*Date of Birth:
*Permanent Address:
*City:Permanent Phone:
*State:*Cell Phone:
*Zip:*E-mail:


*I want to re-enter for ...

Fall (Aug.) 2009 Spring (Jan.) 2010 Fall (Aug.) 2010 Spring (Jan.) 2011
Other (please list term)


Colleges attended

List other colleges or universities you have attended since attending Anderson University. (Transcripts must be submitted to Anderson University prior to approval for re-activation.)

Name of InstitutionCity and StateDate(s) of Attendance



*Have you ever been dismissed, suspended or placed on probation for poor scholarship or disciplinary reasons at Anderson University or any other college? Yes. No.
(If yes, please give details in the box below.)

*Have you ever been convicted for commission of a felony? Yes. No.
(If yes, please give details in the box below.)

*Do you plan to live on campus? Yes. No.
(If yes, you must file a room reservation form with the Department of Student Life.)


Use the following text box to explain disciplinary actions or felony convictions you have received:


*Denotes a required field.

Submitting this form is equivalent to a signature.

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