Office of Registration and Records

APPLICATION FOR READMISSION

** NOTE: Please complete the entire form and submit **

Office of Registration and Records
110 Administration Building
Bowling Green State University
Phone: 419-372-8441
Bowling Green, OH 43403
Fax: 419-372-7977

Last Name :
First Name :
Middle/Maiden Name :

Date of Birth (mm/dd/yyyy):
BGSU ID # :
Last 4 Digits of SSN:
Gender :
Male Female
Marital Status :
Single Married
Email Address :

Ethnicity and Race
Providing the information below is voluntary and will not be used in a discriminatory manner. These questions comply with the U.S. Department of Education's new standard for ethnic and racial data collection.
Ethnicity : Are you Hispanic or Latino?
Yes
Race : (Please check any or all that apply)
American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian/other Pacific Islander
White

Local Address
Effective Date (mm/yyyy) :
Address 1 :
Address 2 :
City :
State :
Zip Code :
Phone
Preferred
Home :
Cell :

Home Address
Address 1 :
Address 2 :
City :
State/Province :
Country :
Zip Code :
Phone
Preferred
Home :
Cell :

Emergency Contact
Relationship :
Father Mother Spouse Other
Name :
Address 1 :
Address 2 :
City :
State/Province :
Country :
Zip Code :
Home Phone :
Other Phone :

Parent/Guardian Address
Name :
Address 1 :
Address 2 :
City :
State/Province :
Country :
Zip Code :

Residency
Are you an OHIO Resident?
Yes No
If yes, what OHIO county do you reside in?
How many years/months have you lived in Ohio?
If not a resident of Ohio, please provide a County and State of residency :

Citizenship
Please indicate your country of birth :
Please indicate your country of citizenship :
Are you a Permanent Resident of the U.S.?
Yes No
If not a Permanent resident or Citizen of the U.S., please indicate your Visa status :

I PLAN TO RETURN TO BGSU :
Year :
FALL TERM (August)
SPRING TERM (January)
SUMMER TERM
Do you wish to continue in the fall? Yes No
Attending : Full-Time Part-Time

Have you ever been convicted of a felony?
Yes No

Are you employed at BGSU?
Yes No
If yes, full time or part time?
Full-Time Part-Time

I last attended BGSU :
Do you have a degree?
Yes No
What degree?
From where?

List schools and dates attended SINCE your last enrollment at BGSU :
What academic college were you enrolled in when you last attended BGSU?
To change to a different college, contact the new college so they may create a file for you and assist you in your degree requirements.
Do you wish to obtain another undergraduate degree from BGSU?
Yes No
What additional degree will you be pursuing?
Expected graduation term :

Notice :
As a condition of admissions to the University and reflecting the educational philosophy of the institution, all freshman- and sophomore-level students are required to live in University residence halls. This policy does not apply to students over the age of 23 or to students commuting daily from the home of a parent, legal guardian, or spouse (commuters must live within 50 miles of Bowling Green), or to students who have attained 60 academic semester hours or four semesters of campus residency before their first day of classes. If you do not meet the criteria for off-campus living according to our residency requirement, you must appeal your circumstance to the Office of Residence Life for a release from your contract. Failure to do so will result in housing charges being placed on your account.
Please contact the Office of Residence Life, 419-372-2011 for appeal information.
I am applying for on-campus residence
or
I plan to reside off campus
By submitting this form, I certify that the information hereon is complete, accurate, and true to the best of my knowledge. I understand that my misrepresentation of facts hereon will cause for refusal of admission, cancellation of admission or expulsion from the University if discovered subsequently. I agree that as a student I am subject to the Code of Student Conduct of Bowling Green State University. As a student enrolled in classes at Bowling Green State University, I agree to assume full financial responsibility for all charges incurred on my student account whether I attend the classes or not. I further understand that my failure to be fiscally responsible may result in service holds, late fees, collection actions by BGSU, the Ohio Attorney General's office or other third party agency, unfavorable credit bureau filing and/or litigation and I will assume all costs associated with such actions.