APPLICATION FOR READMISSION
To be completed by any admitted student who was
enrolled, but has been continuously absent, for two
or more semesters but not more than two years.
READMISSION TO:
(Check one)
䡺 Seaver College – Malibu, CA 90263
䡺 The Graziadio School of Business and Management – 6100 Center Dr., Los Angeles, CA 90045-1590
䡺 Graduate School of Education and Psychology – 6100 Center Dr., Los Angeles, CA 90045-1590
䡺 School of Public Policy – Malibu, CA 90263
PLEASE PRINT OR TYPE
CWID #
LAST NAME FIRST NAME M.I. PHONE NO.
ADDRESS (Number and Street) APT. NO. OR C/O
CITY STATE ZIP CODE COUNTRY (If other than U.S.A.)
BUSINESS PHONE NO. EXTENSION PREVIOUS / MAIDEN NAME (If applicable)
DATE OF BIRTH MARITAL STATUS TITLE SEX U.S. CITIZEN? CALIF. RESIDENT?
MAJOR / PROGRAM RE-APPLYING FOR SEEKING A TEACHING CREDENTIAL? LEVEL
EXPECTED GRADUATION DATE DATE LAST ATTENDED DATE TO RE-ENROLL
䡺 Married 䡺 Not married 䡺 Mr. 䡺 Ms. 䡺 M 䡺 F 䡺 Ye s 䡺 No 䡺 Ye s 䡺 No
䡺 Ye s 䡺 No 䡺 Undergraduate 䡺 Graduate
APPLYING FOR FINANCIAL AID
AT PEPPERDINE?
䡺 Ye s 䡺 No
( )
( )
20 ____ 20 ____ 20 ____
䡺 Fall (Aug/Sept) 䡺 Summer (May) 䡺 Fall (Aug/Sept) 䡺 Summer (May) 䡺 Fall (Aug/Sept) 䡺 Summer (May)
䡺 Spring (Jan) 䡺 Spring (Jan) 䡺 Spring (Jan)
If you answer “Yes” to any of the following questions, please attach an explanation.
Has any college dismissed you or asked you to withdraw? ............................................................................................... 䡺 Ye s 䡺 No
Have you been judged guilty of criminal or civil offenses other than minor traffic violations? ........................................... 䡺 Ye s 䡺 No
NON-U.S. CITIZENS
PLEASE COMPLETE ➤
PREFERRED CLASS LOCATION
(for GSBM or GSEP only) ➤
TYPE OF VISA COUNTRY OF CITIZENSHIP
䡺 F-1 䡺 B-2 䡺 J-1 䡺 PRV (Green card) 䡺 Other:
Please list all colleges attended since leaving Pepperdine University. Official transcripts must be sent directly from all institutions listed to the Office of
the University Registrar at Pepperdine University. Please indicate number of units currently in progress.
I certify, that to the best of my knowledge, the information furnished in this application is true and complete. I agree that, if admitted, I will abide by the
rules and regulations of Pepperdine University as contained in the current University catalog. All official transcripts which I forward to the University
become the property of the University and will not be forwarded to another institution nor returned to me. If there is a policy dispute between me and the
University, the appropriate catalog will be used as the arbitrating medium.
Signature of Applicant: X _____________________________________________ Date: ___________________________________
Pepperdine University is pleased to consider all applicants without regard to race, color, sex, religious affiliation, national origin, or non-disqualifying handicap.
FOR OFFICE USE ONLY
ADMISSIONS APPROVAL
DATE
CAMPUS LIFE / SCHOOL APPROVED
DATE
FINANCE APPROVAL
DATE CREDITS COMMITTEE APPROVAL DATE
COLLEGE(s) ATTENDED
(Use additional sheet if necessary)
LOCATION
City / State
DATES (Mo/Yr)
From To
MAJOR
NO. OF
UNITS
DEGREE
Received Mo / Yr
15.054 (4-04)
