Application for Readmission-San Juan Bautista

APPLICATION FOR READMISSION
A NON-REFUNDABLE READMISSION APPLICATION FEE OF ONE HUNDRED DOLLARS ($100.00) IS REQUIRED.

*PLEASE SUBMIT THE PAYMENT AT THE END OF THIS FORM.
PART A: STUDENT DATA
SELECT THE PROGRAM YOU WISH TO APPLY FOR READMISSION.*
Name:
LAST (FAMILY NAME)*
FIRST*
MIDDLE
PREVIOUS NAME (IF APPLICABLE)
Permanent Address
STREET*
CITY*
STATE*
ZIP*
Telephone*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Student ID Number*
REQUIRED FOR FINANCIAL AID
Gender

MaleFemale
Domicile*

In-StateOut-of-StateInternational
Non-SJBSM Email (Personal Email)*
example@example.com
Would you like on-campus housing information?

Future Enrollment Plans
Planned Entrance Date*

FallSpring
Academic Year*
Planned Enrollment Status*

Part-TimeFull-Time
Previous SJBSM Attendance
Semester/Year of last attendance (Example: Fall/20XX or Spring/20XX)*
Class/Status at time of withdrawal (e.g., Class of 2002)*
Previous Program*
Intended Major (if requesting a change)
Colleges Attended Since Leaving the University (If Apply)

You can name up to two Colleges or Universities.
1. COLLEGE/UNIVERSITY
CITY/STATE
CREDITS EARNED
DATES ATTENDED

MonthDayYear
Date
DEGREE EARNED
2. COLLEGE/UNIVERSITY
CITY/STATE
CREDITS EARNED
DATES ATTENDED

MonthDayYear
Date
DEGREE EARNED
(If Apply) Upload or Submit an official transcript from every college or university you have attended since your last enrollment at SJBSM to the Registrar's Office, PO Box 4968, Caguas, Puerto Rico 00726-4968
Upload an Official Transcript

Cancelof

List in order, beginning with present or most recent, all employment and/or volunteer or internship activities, along with Start and end dates, since leaving SJBSM.

You can name up to three Companies or Organizations.
1. Name of Company/Organization
From

MonthDayYear
Date
To

MonthDayYear
Date
2. Name of Company/Organization
From

MonthDayYear
Date
To

MonthDayYear
Date
3. Name of Company/Organization
From

MonthDayYear
Date
To

MonthDayYear
Date

*By my signature, I certify that the information I have provided about my academic and personal history and residency is accurate and complete. Failure to disclose any required information could result in the denial of readmission or retroactive administrative withdrawal from the University without refund or course credits. I understand that it is my responsibility to submit a completed readmission application by the stated deadline. Failure to do so may resultinmy application being withdrawn without review.
Signed under the penalties of perjury, this date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Applicants signature*

Clear
Print name*
*Important! (You must complete this part after submitting this form.)

Please read the (PERSONAL STATEMENT) instruction below and send the statement to the Associate Dean for Student Affairs at the following email (ymiranda@sanjuanbautista.edu).

PERSONAL STATEMENT

Prepare a thoughtful personal statement: Provide a detailed statement outlining your experiences at SJBSM and the circumstances that led to your separation. Explain how you have spent your time away from SJBSM (e.g. medical treatment, paid/volunteer work, academic coursework, other activities) and how these experiences have been productive and helpful to your understanding of what changes must be made in order for you to succeed as a SJBSM student. If you received medical treatment, list the medical, psychological or health professionals you have seen, and the number of visits to each. List any drugs that you are taking for this problem, the side effects that you have encountered that might affect your ability to attend and complete classes (e.g. drowsiness, inability to concentrate) for continuing to work with a health professional after you return to SJBSM.
SJBSM Readmission*
prevnext( X )
Readmission Fee
$100.00

Total

$0.00
Should be Empty:

APPLICATION FOR READMISSION

PART A: STUDENT DATA

Name:

Permanent Address

Future Enrollment Plans

Previous SJBSM Attendance

Health Withdrawal

Late Withdrawal