USI » Office of the Registrar » Readmission Application Request

Complete the form below to submit your Application for Undergraduate Readmission to the University of Southern Indiana. If you have questions regarding this form, please call 812/465-1157 or 800/467-1965 (#3).

Fields marked with an * are required.

Student Information

* Intended Enrollment Period:

Enroll Year

Enroll Term

* Student ID Number or
Social Security Number:

Ex. 000123456

* Full Name:

First Name

Last Name

Maiden Name:

* Ethnic Origin:

* Email Address:

* Birth Date:

mm/dd/yyyy

* Marital Status:

* Gender:

Male Female

Emergency Contact Information

* Contact Name:

* Contact Phone:

ex. 3174659121

* Contact Relationship:

Local Address Information

* Street Address Line 1:

Street Address Line 2:

* City, State, Zip:

City

State

Zip Code

* Phone Number:

ex. 3174659121

Permanent Address Information

* Street Address Line 1:

Street Address Line 2:

* City, State, Zip:

City

State

Zip Code

* Phone Number:

ex. 3174659121

* Country:

Additional Information

* Do you plan to change your major at this time?

If YES, you must complete a Change of Academic Program form located in the Registrar's Office.

* Have you ever been convicted of a felony or crime against another person?

* Are you an Indiana Resident?

* Citizenship

If not a U.S. Citizen, please complete:

Visa Type:

Citizenship Country:

Birth Country:

* Are you a veteran or currently in military service?

Education Background Information

Please Note: List all colleges and universities you have attended since you last attended USI. Failure to do so is sufficient cause to refuse consideration of an application or to dismiss a student who has been granted readmission.

* Are You Currently Seeking A Degree From Another Institution?

College #1:

College City, State:

City
State

Dates Attended:

From (mm/yyyy)
To (mm/yyyy)

College #2:

College City, State:

City
State

Dates Attended:

From (mm/yyyy)
To (mm/yyyy)

College #3:

College City, State:

City
State

Dates Attended:

From (mm/yyyy)
To (mm/yyyy)

Important: It is required that degree-seeking students submit for evaluation a current, official transcript from each of the aforementioned institutions. Your transcripts must be sent directly from the institution to the Office of the Registrar at USI.

Other Information

ONLY USI Graduates - I Am Returning For:

Additional Degree (30+ Hours) - Must File Change of Major

Additional Major/Minor Change (< 30 Hours)

Teacher Certification/License

Personal Enrichment/Other

Notes and Comments:

8600 University Boulevard - Evansville, IN 47712-3596 - 812/464-8600

Other Information

ONLY USI Graduates - I Am Returning For:
Additional Degree (30+ Hours) - Must File Change of Major
Additional Major/Minor Change (< 30 Hours)
Teacher Certification/License
Personal Enrichment/Other

Notes and Comments: