Admissions Reactivation Form
Please use this reactivation form if you have previously applied for admission to UMass Dartmouth within the last academic year. Applicants who submitted an application more than one year ago must complete the Application for Admission for further consideration. Biographical Information

Last Name

First Name

MI

Birth Date (mm/dd/yyyy)

Permanent Address

Street

City

State

Zip

Mailing Address

Street

City

State

Zip

Phone Number Application Information

Cell Phone Number

Email Address Intended Major

I originally applied for the following term: I would like to reactivate for the following term:

Fall 20 _____ Fall 20 _____

Spring 20 _____ Spring 20 _____

1st choice _____________________ 2nd choice ____________________

Please indicate the institution(s) attended since you last applied:

Institution Name

Dates Attended

Institution Name

Dates Attended

Please submit official transcript(s) from institution(s) listed above to the following address: UMass Dartmouth – Office of Admissions – 285 Old Westport Road – North Dartmouth, MA 02747-2300 Other Required Information Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion for the institution?  Yes  No Have you ever been convicted of a misdemeanor, felony or other crime?  Yes  No If you answered “yes” to either or both questions, please submit a separate sheet that gives the approximate date of each incident and explains the circumstances. Mail directly to the Director of Admissions at the Office of Undergraduate Admissions and mark the envelope CONFIDENTIAL. We will carefully review the circumstances surrounding your situation. A “yes” answer does NOT necessarily disqualify you for consideration for admission to the University of Massachusetts Dartmouth. Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.

I certify that the information on this form is complete and correct, and I understand that the submission of false information is grounds for denial of my application, withdrawal of any offer of acceptance, cancellation of enrollment or any appropriate disciplinary action. I authorize UMass Dartmouth to verify the information I have provided with all the schools I have attended. I agree to notify the proper officials of the institution of any changes in the information provided.

Signature

Date