Application for Renewed Enrollment

Please use this form only if you are a former Butler student and were not in attendance last semester. If you wish to change your student status (ex: change from undergrad to grad, or change to degree-seeking), you must apply for readmission to the university and may not use this form. Go to www.butler.edu and click on Admission.

Renewed enrollment forms should be submitted one week before the first day of classes.

Personal Data

First Name

Middle Name

Last Name

The name under which you last attended, if different (In order to complete a name change on your records, we will need to see your new name on your Social Security Card, and the legal document which authorizes this name change, such as a Marriage Certificate.)

Birthdate

Citizenship

Home Address

Country

Street

City

Region

Postal Code

Mobile Phone

Home Phone

Email Address

Have you attended another college or university since you were last at Butler?

Yes

No

College Name

Level of study

CEEB

Start Date

End Date

Degree Earned

Please have official transcripts sent to Butler University Office of Admission, 4600 Sunset Ave, Indianapolis, IN 46208. These must be received prior to review for readmission.

Butler Information

Butler ID (if known)

Term Returning

Year Returning

Please indicate your student status when you were last enrolled

When did you last attend Butler? (e.g. Spring 2024)

Please provide your expected graduation term (e.g. Spring 2024)

Please select the Butler College where you were last enrolled

Are you in good academic and disciplinary standing at your prior institution and eligible to be enrolled at that institution?

Yes

No

Please list the reasons.

Have you ever been found responsible of a disciplinary violation at your previous high school, college or university for any action involving violence, physical force or the threat of physical force, a sexual offense, stalking, possession of a weapon, kidnapping, arson or any offense which caused harm to another person?

Yes

No

Please give the approximate date(s) of each incident, explain the circumstances and reflect on what you learned from the experience.

Within the last seven years after the age of 14, have you ever been convicted, or plead guilty or entered a plea of nolo contendere to a criminal offense involving violence, physical force or the threat of physical force, a sexual offense, stalking, possession of a weapon, kidnapping, arson or any offense which caused harm to another person? You should answer “no” if your conviction or plea has been sealed, expunged, or overturned or if you were arrested but not charged or convicted.

Yes

No

Please provide the details of your criminal conviction or adjudication and reflect on what you learned from the experience.

I certify the information on this application in factually correct. I understand willful omission or misrepresentation of information may make me ineligible to return or may subject me to later dismissal. Any student who decides to attend Butler University is expected to comply with all rules and regulations promulgated by the university.

Signature

Date

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