Application for Readmission

Personal Information
Name
Last First M.I.
Any other name(s) used while attending Buffalo State College
Address
Street Street 2
City State Zip Code
County of Permanent Residence
Personal Information
Gender
Date of Birth
Banner ID (if known)
Are you Hispanic/Latino? Yes No
If Hispanic/Latino, what is your background?
All Applicants, please indicate your race (select one or more)
American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander
White
Contact Information
Daytime Phone Number ()- Evening Phone Number ()-
Email Address:
Previous Coursework
Semester you want to enter Buffalo State: Year    Term
Date last attended Buffalo State?
Do you have a degree from BSC? Yes No
Did you leave Buffalo State for active duty in the military within the last five (5) years? Yes No
    If yes, please provide us with a copy of your DD214 form
First entered Buffalo State College as General Freshman International Student
General Transfer EOP Freshman/Transfer
Intended Major Code
Have you ever been:    A) Convicted of a felony?Yes No
B) Dismissed from a college for disciplinary (NOT academic) reasons?Yes No
C) Dismissed from a college for academic reasons?Yes No
If yes, When/for how long?
List other college(s) and dates attended since leaving Buffalo State
Failure to report other colleges attended could result in dismissal from Buffalo State.
Confirmation
The information on this form is accurate and complete to the best of my knowledge. The University reserves the right to validate the information at any time and, if found fraudulent, to take necessary actions. I understand that a permanent transcript of my work as a non-degree student will be maintained at Buffalo State and that I am responsible for all tuition and fees that will result from registering for courses at the college.
By checking this box I agree that all the above is true