Application For Readmission
Answers marked with a * are required.
 
 
1. Last Name *
 
 
 
2. First Name *
 
 
 
3. Middle Name
 
 
 
4. Maiden/Former Name
if applicable
 
 
 
5. Preferred First Name *
 
 
 
6. Address
Street Address or PO Box, City, State, and Zip Code *
 
 
 
7. Home Phone *
 
 
 
8. Cell Phone *
 
 
 
9. Email Address *
 
 
 
10. Date of Birth *
 
 
 
 
 
 
11. Have you been officially reprimanded by school officials or civil authorities since your previous enrollment? *

      
 
 
 
12. If yes, please provide a written explanation.
 
 
 
 
 
 
Academic Information
  
 
 
13. First term at YHC *
 
 
 
14. Last Term at YHC *
 
 
 
15. Status *



      
 
 
 
16. Re-Entry Term
Fall, Spring or Summer + Year | Example: Fall 2011 *
 
 
 
17. Intended Major
 
 
 
18. Indicate where you plan to live: *

      
 
 
 
19. Please list all colleges/universities you have attended since leaving YHC. List the most recent first. You must request copies of all transcripts to be sent to YHC, Office of Admissions.
  Institution Degree & Major Dates Attended Graduated?
1
2
3
 
 
 
20. Why did you withdraw from YHC? *
 
 
 
21. Why do you wish to re-enroll? *