Davis College Online Courses or On Campus in New York: A Distinctly Christian Values-Based Accredited College of Ministry

Davis College Application for Re-Admission

Please note: After submitting this form, you will receive an email confirmation that we have received your application for re-admission. Your email address is a required field below.

I understand and accept the commitment of Davis College to be a distinctly Christian, values based institution and have read and agree to the Davis College Covenant.

Personal Information

First Name: Middle Initial: Last Name:

Email Address (required):

Street: City:

County of Residence (not "Country"): State: Zip:

Are you a United States Citizen?: Yes No

Are you a Veteran?: Yes No

Phone (XXX-XXX-XXXX):

Age: Birth Date (MM/DD/YY):

Gender: Male Female

Social Security Number: Marital Status:

Church Activities:

Volunteer/Community Service:

For Statistical Purposes: Please check one of the following:
White, Non-Hispanic	Black, Non-Hispanic
Non-Resident Alien	Asian or Pacific Islander
Hispanic	American Indian/Alaskan Native
Race Ethnicity Unknown

Davis College does not discriminate on the bases if race, color, sex, disability, or ethnic origin.

Course Information

Desired Course Load: Full-time Part-time
Desired Living Accommodations: Campus Resident Commuter

Desired Re-Entry to Davis College: Fall Spring 20

Program Choice

Select the program you would like to pursue at Davis College:

*Please select one concentration below:

4 + 1 in Elementary Education

If you have chosen 4+1, you must also choose a concentration. This information can be updated if you decide to change concentrations at a later date.

Site:

Last Semester Enrolled at Davis College:

Reason for Leaving:

Transfer Personal Disciplinary Graduated Other

List any college(s) or post-secondary school(s) attended since last enrolled at Davis College:

(An official college transcript is required for review of possible transfer credits.)

Recommendation Information

List two non-family members, other than a church leader, that Davis College may contact for a personal referral (teachers, guidance counselors, and employers are recommended).

1. Name:

Complete Address (Street, City, State, ZIP):

Email:

Phone (XXX-XXX-XXXX):

2. Name:

Complete Address (Street, City, State, ZIP):

Email:

Phone (XXX-XXX-XXXX):

Have you been convicted or prosecuted for a crime in the last 12 months? Yes No

If yes, please explain:

Have you used any of the following in the last twelve months?
(If yes, mail a letter of explanation to Admissions.)

Tobacco? Yes No

Alcohol? Yes No

Narcotics? Yes No

Health Records from previous enrollment period need to be reviewed and/or updated with Health Services.

Thank you for submitting your readmission application online!

You will receive confirmation by email when it is received by the admissions office.