Application for Readmission

Student Information

Student's Legal Name (last, first middle)

Student's Contact Information

Number and Street

PO Box / Apartment Number

City

State

ZIP Code (5 digits)

Country

Student's Phone

Student's Email

Anticipated Return Date

Time out of school

Have you taken time out of school since leaving Providence College?

NoYes

From date

To date

Please list the major activities, including employment, which would tell us how you spent your time away from school.

Colleges/Universities Attended

Please list all Colleges/Universities attended since leaving Providence College, if applicable.

	Name of Institution	Start date	End date

What is your intended major?

Please compose a statement of your reasons for requesting a return to Providence College.

Discipline History

Since leaving Providence College, have you been found responsible for any type of

academic integrity policy or conduct code violation at any educational institution that

resulted in probation, suspension, or dismissal?

YesNo

Please compose a statement with an explanation of the violation.

Have you ever been found guilty or convicted of a misdemeanor or felony?

YesNo

Please compose a statement with an explanation of the conviction.