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Application For Readmission

NOTE: Parkville 16-week Program

This form is for students who have attended Park University -Parkville Campus in the past. Complete information is essential to your readmission. If you have never attended the Parkville 16-week Program, please contact the Office of Admission at 816-584-6214.

All fields are required except as stated

Parkville Daytime Campus Center only at Park University:

Session to start: Year:

First Name:

Last Name:

Social Security #:

Mailing Address:

City: State: Zip:

Phone:

Park Email:

Are you a returning Veteran? Yes No

Intended Major:

Intended Second Major (optional):

Intended Minor: (optional)

Reason for leaving Park:

Last semester attended at Park University: Year:

Colleges attended since leaving Park University: (you must submit transcripts of all work attempted since leaving Park University.)

Institution Name: Dates attended:

I hereby certify to the best of my knowledge the information given by me on the application is complete and I understand that any misrepresentation may be cause for denial or cancellation of admission. I also understand that a transfer student will under no circumstances be granted credit for any previous college work not acknowledged at the time of admission. I further pledge to comply with all rules and regulations which Park University has found to be valuable in the maintenance of this academic and social standards of life and conduct.

Please provide your birthday for verification that you agree to all of these facts being true to the best of your knowledge and belief, which is the equivalent of your signature.

Birthday:

Having trouble completing this form? Have questions? Give us a call at the SAC! We can help at 816-584-6800.

Park does not discriminate on the basis of race, color, creed, sex, age, religion, marital status, national origin, public assistance status or disability in the administration of educational and admission policies, financial assistance, athletic or other school related programs. If you have comments or questions about this policy as it applies to Park University, contact the Human Resources Office at (816) 741-2000, extension 6386.

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