Readmission Application
PLEASE USE INTERNET EXPLORER TO COMPLETE APPLICATION

Undergraduate students who have interrupted their course of study for at least two semesters, or who have finished serving an academic suspension of any length, must apply for readmission in order to come back to UNCP.

Your failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw your admission, or dismiss you after enrollment. By signing this application, you are granting permission for a criminal background check if deemed necessary. Please note there is a $25.00 readmission fee that must be paid prior to processing your application. To pay your readmission fee with a card, please call the bursar office at 910-521-6855 and then include the receipt number on this application. To pay with cash, money order or check , please send to the address below.

The Center for Student Success
Attn: Braves Come Back
P.O. Box 1510
Pembroke, NC 28372.


If you are taking graduate level courses please contact the School of Graduate Studies.

First Name *
Your answer
Middle *
Your answer
Last Name *
Your answer
If you attended UNC Pembroke before under a different name, please indicate that name here. *
Your answer
BANNER ID
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Marital Status *
Your answer
Race (Please select all that apply)
Gender
Permanent address can NOT be a residence hall type address
What is your permanent street address?
Street *
Your answer
City *
Your answer
State/Province *
Your answer
Zip Code *
Your answer
Country *
Your answer
Home telephone *
Your answer
Work telephone *
Your answer
Cell telephone *
Your answer
Email address: NOT a BraveMail account, personal email (please note this will be our primary form of communication) *
Your answer
Receipt Number for $25 Readmission Fee
Your answer
Have you attended any other academic institutions since you last enrolled at UNC Pembroke? *
If you answered yes to this question, you must list all academic institutions you have attended since leaving UNC Pembroke.
Your answer
Choose your track of study (Required) *
What will be your entry status? *
When do you plan to return to UNC Pembroke? *
Tell us in your own words what you have been doing since your departure from UNC Pembroke.
Your answer
When did you last attend UNC Pembroke (Please include semester and year, ex. Fall 2003) *
Your answer
Have you complied with the North Carolina Immunization Law? *
North Carolina Immunization Law:
All students must comply with the North Carolina immunization laws. Returning students that fail to demonstrate compliance will be cancelled from their classes and withdrawn from the university. Please contact UNC Pembroke's Student Health Services (http://studentaffairs.uncp.edu/student-health/)
Campus Safety Questions
Your "yes" answer to one or more of the following questions will not necessarily preclude your being admitted. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your admission, or to dismiss you after enrollment.

For the purpose of the following six questions, "crime" or "criminal charge" refers to any crime other than a traffic-related misdemeanor or an infraction. You must, however, include alcohol or drug offenses whether or not they are traffic related.

Have you been convicted of a crime? *
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea, or have you received a deferred prosecution or prayer for judgment continued, to a criminal charge? *
Have you otherwise accepted responsibility for the commission of a crime? *
Do you have any criminal charges pending against you? *
Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any institution of higher education? *
If you have ever served in the military, did you receive any type of discharge other than and honorable discharge? *
Current Military Status
If you answered "yes" to any of the six questions above, please explain the circumstances below. If you answered "no" then type "N/A" in this box to finish.
Your answer
Campus Safety Questions
You must promptly notify the Office of the Registrar in writing of any criminal charge, any disposition of a criminal charge, or any school, college, or university disciplinary action against you, or any type of military discharge other than a honorable discharge that occurs at any time after you submit this application. Your failure to do so will be grounds to deny or withdraw your admission, or to dismiss you after enrollment. By signing this application you are granting permission for a criminal background check if deemed necessary
North Carolina Residency
Your residency for tuition purposes determines your in-state or out-of-state status and may impact your admission, tuition, scholarship or financial aid eligibility. North Carolina residency for tuition purposes is governed by North Carolina state law. More information about North Carolina residency for tuition purposes can be found at www.ncresidency.org
Do you claim to be a North Carolina Resident? *
If you claim to be a North Carolina resident for Tuition purposes enter your Residency Certification Number (RCN):
Your answer
Residency Certification
*If you claim to be a North Carolina resident for Tuition purposes, and do not have your Residency Certification number (RCN), please visit the link below.

To learn more about residency and complete a determination; go to Residency Determination Service (RDS) at www.ncresidency.org. Without your Residency Certification Number (RCN), you are currently ineligible for classification as a North Carolina “resident for tuition purposes” and will be charged out-of-state tuition and not be given consideration for State financial aid.

Once you receive your Residency Certification Number (RCN), you can provide it directly to the Center for Student Success, when available, by emailing bcb@uncp.edu.

Are you an Out of State Resident?
Are you a U.S. Citizen *
If you are NOT a U.S. Citizen, please list country of citizenship below
Your answer
I UNDERSTAND THAT WITHHOLDING INFORMATION
requested in this application or giving false information may make me ineligible for admission to/or continuation at The University of North Carolina at Pembroke. With this in mind, I certify that the statements herein are correct and complete. I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment. Please allow one week for processing. Please note that you will not receive a decision until October.
Please initial that you understand the above statement. *
Your answer
Available in an Alternative Format
This publication is available in alternative formats upon request. Please contact Accessibility Resource Center, DF Lowry Building, 521-6695.


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