Name:

Street Address:

City:

State:

Zip code:

Preferred Day Phone Number:

Email Address:

Are you applying for Financial Aid?

Are you using GI Bill® benefits?

Which semester are you applying for Readmission?

What degree are you seeking?

What major/program are you seeking?

When did you last attend Elizabethtown College?

What was your primary reason for withdrawing from Elizabethtown College?

Have you attended any other college since leaving Elizabethtown College?

If Yes, please have the institution send an official transcript to the Office of Registration and Records (One Alpha Drive, Elizabethtown, PA 17022).