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Returning Undergraduate CSC Students

Chadron State College Re-Admit Application

Students who have not been enrolled at CSC for one to five years may use the "Returning CSC Students" form below. Students who have not been enrolled at CSC for more than five years are required to fill out a new application for admission.

Student Information

First Name

Middle Name

Last Name

Name when you last attended CSC (if different than above)

Phone Number

Email Address

Academic Major

City

State

Zip Code

Street Address

Incoming Term

Will you be an Online Student or an On Campus Student?

On Campus Online

Additional Information

Date you last attended CSC

Have you been suspended from another college since you last attended CSC?

Yes | No

Have you ever been convicted of a crime other than a minor traffic offense? Note: a conviction record is not an automatic bar to admissions. This will be determined on a case-by-case basis.

Yes | No

Colleges/Universities you have attended since CSC

Name of First Institution	Credits Earned	Date(s) Attended

Name of Second Institution	Credits Earned	Date(s) Attended

Name of Third Institution	Credits Earned	Date(s) Attended

Name of Fourth Institution	Credits Earned	Date(s) Attended

I certify that the information I have provided above is complete and true to the best of my knowledge without evasion or misrepresentation. I understand that if it is later found to be otherwise, it will be sufficient cause for denial or suspension and forfeiture of all fees and deposits.

Signature

Date: Mar-15-2010

Security Code