Graduate Re-Entry Application for Former
Houston Baptist University Students

 

Graduate Program: ___________________                  Last Quarter Attended: __________

 

Quarter and year to re-enter: _______                 Social Security Number: ______-_____-________

 

 

(Please print in ink or type)

 

Name: ________________________________________________

           Last                              First                         Middle

 

 

Name: ________________________________________________

* other name(s) under which records could be listed

                                       

*Note: Name as it appeared when previously enrolled. A name CHANGE form must be obtained and completed from the HBU registrar’s Office before your name change is reflected on your HBU record.

 

Present Mailing Address                                                                                  Home Phone (____)_______________

 

______________________________________________

 

______________________________________________                                    Business Phone (        ) ____________

City                          State        Zip Code                  County

 

Permanent Mailing Address (if different from above)

 

______________________________________________

 

______________________________________________                                   

City                          State        Zip Code                  County

 

 

___U.S. Citizen                        ___Resident Alien                   ____Permanent Resident        ____Political Asylum

 

___Visa- If yes, what visa __________________

 

FOR OFFICE USE ONLY

 

 

TOT ATT _______                 TOT ERN_______                   TOT PTS ________                                TOT GPA ________

 

Accepted: _________________________________           Date: ________________________

                                Program Director

 

Accepted: _________________________________           Date: _________________________

                      Vice President for Academic Affairs

 

Notification: ________________________________

 

 

 

 

 

 

 

 

 

 

 

 

Continued on page 2

 

 

Graduate Re-Entry Application Page 2

 

MED: (     )  Curriculum and Instruction

 

Do you plan on receiving a graduate degree at Houston Baptist University?          Yes (     )  No (     )

 

Have you received a graduate degree from Houston Baptist University?                                Yes (     )  No (      )

 

 

List all colleges or universities in which you have enrolled since leaving Houston Baptist University.  Official transcripts from each college or university attended since leaving Houston Baptist University must be submitted.

 

College or University                                          Date Attended                                      Degree

 

 

Are you on probation or suspension at any institution of higher learning

including Houston Baptist University?                                                                            Yes (     )  No (     )

 

 

Fax both pages of this form to the following:

 

Houston Baptist University-Masters Online Program

Attn: Ida Thompson

Fax:        281.649.3011 

Phone:   281.649.3295