Mail completed Application for Re-admission to the Graduate School, Eastern Illinois University, Charleston, IL 61920-3099 or Fax to (217)581-6020. Call after faxing to make sure re-application was received.

Have you previously earned a degree at Eastern (check one) YES_____ NO_____

Name (Last, first, Middle, Previous)________________________________________

Social Security # or EIU E #______________________

Do you wish a name change (yes/no) __________

Re-admission for (semester/year) __________Last Attended Eastern (semester/year) __________

Street Address ________________________________________________________

City _________________________State _____ ZIP __________

Phone No. ________________________________

Birth Date ____________ Marital Status (check one) Single _____ Married _____

U. S. Citizen (check one) YES _____ No _____

Degree Seeking ______________________________ Major ______________________________

Former Major ______________________________

Former Advisor ______________________________



Date____________________ Signature ________________________________________
E-Mail Address__________________________________

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To insure proper handling, completed application must be mailed to the GRADUATE SCHOOL, EASTERN ILLINOIS UNIVERSITY, CHARLESTON, IL 61920-3099

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Holds__________ Classification__________ Academic Standing__________ New File_____ Ent. P.6_____

Sum. Card__________ ILO__________ Permit__________ Date Sent_______________