RETURNING Undergraduate STUDENT APPLICATION

Name












Last, First, Middle


Address:






Phone#



















City, State Zip

Email:








Date of Birth:

Campus Wide ID:



Gender: Male Female

Check ‘ ’ the Term you plan to re-enroll at Mines, and insert the corresponding Year next to the term.

Summer Session One:



Summer Session Two:





Fall Semester:




Spring Semester:



Are you seeking another undergraduate degree from Mines?





If yes, prior Mines graduation date:







month/year









Dates of previous attendance



to





Class standing when last attended: Sr Jr Soph Fr Degree/Major Option:





Have you ever been on suspension from Mines?

Dates:






Are/were you required to see the Readmission’s Committee before registering again at Mines?


Date:
Time:






Country
of
Citizenship:
Ethnicity






I hereby affirm all the information supplied on this form is true to the best of my knowledge.

Student
signature

Date






Please email back to admit@mines.edu or mail to:
Colorado School of Mines, Admissions Office, 1600 Maple Street, Golden, CO 80401

Toll free: 1-888-446-9489 Fax: 303-273-3509 303-273-3220 www.mines.edu