Application for Readmission: Registrar : Saint Mary's College of California

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Application For Readmission

*Please note that this form must be submitted one month prior to the term

Proposed Readmission Term:

Readmission Year:

Personal Data

First Name:

Middle Name:

Last Name:

Surname while attending SMC:

ID#:

Phone #:

Email:

Current Address

Address:

City:

State:

Zip:

Permanant Address

Address:

City:

State:

Zip:

Withdrawal Information

Type of Withdrawal:

Last term of attendance at SMC:

(e.g., Fall 2008)

Explain the reasons or circumstances for your leaving SMC:

How have these circumstances changed?:

If reason for withdrawal was a health problem, have your physician submit a report on your current health status

Academic Pursuits

List below colleges you have attended since leaving SMC. Have an official transcript from each institution sent directly to the Office of the Registrar to the following address:

Office of the Registrar
P.O. Box 4748
Moraga, CA 94575

Institution	City & State	Units or Degree Earned	Dates Attended

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Readmission Information

Intended Major:

State why you wish to be readmitted to SMC:

Saint Mary's College Of California