Nyack College/ATS Re-Enrollment Form


Personal Information

First Name:
Middle Name/Initial:
Last Name:
Maiden/Previous Name:
Date of Birth:
Date of Last Attendance at Nyack/ATS:
Zip Code:
Home Phone:
Mobile Phone:
Previous Campus:
Intended Campus:
Re-Admittance Term:
Re-Admittance Year:
Degree You Were Pursuing When Last Enrolled:
Audit Only
Will You Enroll Into the Same Degree?:
If Not, Which Degree/Status Do You Intend to Pursue?:
Other Schools Attended Since Leaving Nyack/ATS
School Name 1:
School City/State 1:
School Name 2:
School City/State 2:
Name/Address of Personal or Pastoral Reference
Reference Name:
Reference Contact:
Reference Position/Role:
Briefly Explain Why You Withdrew from Nyack/ATS:
What in Your Life Has Changed Since You Last Attended Nyack/ATS:
Have You Ever Been Convicted Or Charged of a Crime in the US or Any Other Country?:
In order to be considered for re-admission, you must have a zero balance, meet the minimum GPA requirements for your program, provide a reference, and submit transcripts from schools attended since leaving Nyack College/ATS.

*If absent from Nyack College/ATS for more than six years or changing to a program with different admissions requirements, you must go through the full admissions process for your intended program.
   I understand and agree to these conditions