Edward Waters College

Application for Readmission

1658 Kings Road Jacksonville, FL 32209-6199 Tel. No. (904)470-8000

Email Address	* Please enter your email address
Subject	Application for Re-Admission
Last 4 Digits of Social Security No.	Please enter your last 4 digits of SSS No.
EWC ID No.
Last Name
First Name
Middle Initial
Previous Name (Maiden name or other)
Street Address	*
City	*
State	*
Zip Code
Country
Home Phone
Other Phone
Date of Birth	YYYY/MM/DD
Gender	Male Female
Marital Status
Ethnic Origin
Have you been convicted of a felony?	Yes No
If yes, please use a separate sheet to provide a brief and concise description of the circumstances and outcome. Keep in mind, the College reserve the right to request official documentation if deemed necessary.
Indicate Term
Indicate Year
Academic Major
Last semester enrolled at Edward Waters
First semester enrolled at Edward Waters
Have you attended any college or university since your last enrollment at Edward Waters?	Yes No
If Yes, please indicate institutions and dates of attendance below. Please use a separate sheet to include additional schools if necessary.
1.) College Name
Location
Date Attended - From/To
Total Credits
GPA
2.) College Name
Location
Date Attended - From/To
Total Credits
GPA
I certify I have supplied complete academic historical data.
I understand that failure to give complete and accurate information on this application may result in the immediate cancellation of my application, or if admitted, dismissal from the College.
Signature of Applicant	*