College of Applied Health Sciences Re-Entry Application / New Form

Personal Information

Thank you for your interest in applying for re-entry with the College of Applied Health Sciences. Please complete the application below.

Applications are required for those students who:
- Left the University on drop status or on probation
- Have been away from the University for more than one semester
- Are applying to a different academic program (major)

It is your responsibility to include any supporting documentation with this application at the time of submission. Examples of this documentation include:

Unofficial transcripts or grade reports for in-progress coursework. This is very important to include in order to speed up the review process.
NOTE: Official transcripts from any other institutions(s) you attended while not at the University of Illinois at Urbana-Champaign are required. Please send to: University of Illinois, Office of Undergraduate Admissions, 901 W. Illinois St., STE 103, Urbana, IL 61801
Letter(s) of support from any medical professional(s) whose care you are or may have been under.

For any questions about the application process, call 217-333-2130 or email ahs-acaffrs@illinois.edu.

First Name:*

Last Name:*

UIN:

Date of Birth:*

Email Address:*

Do not use your Illinois email account.

Email Address 2 (if you have one):

Phone:

Street Address:*

EX: 123 Main St.

City, State and Zip Code

EX: Urbana, IL 61801

Term you are seeking return to the College of AHS:*

Fall

Spring

Summer

Year you are seeking return to the College of AHS:*

(e.g., 2022, 2023, etc.)

Major to which you wish to be admitted:*

Community Health

Interdisciplinary Health Sciences

Kinesiology

Recreation, Sport, & Tourism

Speech & Hearing Science

If your intended major has a concentration and you know which concentration you want to pursue, please list it here:

Last Date of Enrollment at the University of Illinois:*

University of Illinois College of Last Enrollment:*

(e.g., AHS, DGS, LAS, etc.)

Major of Last Enrollment:*

Supporting Documentation 1. If you have supporting documentation, please upload it as a PDF here:

Supporting Documentation 2. If you have additional supporting documentation, please upload it as a PDF here:

Supporting Documentation 3. If you have additional supporting documentation, please upload it as a PDF here:

Supporting Documentation 4. If you have additional supporting documentation, please upload it as a PDF here:

Current Coursework

List any college courses you are currently taking. This information will be used to compute the total semester hours you will have earned by your desired term of re-entry. It is very important that you provide complete and accurate information.

If you have taken any past coursework at another institution(s), you must attach unofficial transcripts above so that we may complete a preliminary review (and reach a preliminary decision for you).

A final decision on your re-entry application cannot be made until we receive an official copy of your final transcript for all courses completed while away.

Please note that failing to report coursework you have completed registered for at another institution is a violation of the Student Code and will result in disciplinary action up to dismissal from the University

Please enter information for courses you are currently taking (if applicable):

Please enter information for courses you are currently taking (if applicable):
Institution	Term/Year	Dept/Course Number Ex: Math 112 - Algebra	Current Grade

Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade
Institution	Term/Year	Dept/Course Number	Current Grade

Note: You are not necessarily required to have taken courses while away.

Why do you wish to pursue this major?*

What have you been doing since you left the University? Include such activities as employment, military service, enrollment at other institutions, extensive medical treatment, travel, or any other activities that you consider significant.*

I understand that I must request that official transcripts be sent directly to the University of Illinois Urbana-Champaign from all institutions attended since my last enrollment at the University of Illinois Urbana-Champaign as part of this re-entry application. I certify that I have reported all institutions attended and understand that failure to report attendance at another institution is a violation of the Student Code*. I understand that a national enrollment check will be performed to verify I have not falisified my application for re-entry and that this verification will return all institutions I have attended. I also understand that final action on my re-entry will not be taken until all such transcripts have been received.*

*Student Code, Article 1 Part 3 - Student Discipline

Academic standing in last semester of enrollment:*

Good Standing

Academic Warning or Drop Status

What factors caused your previous academic difficulties or leave from the University?

Describe any adjustments that you might have made in your personal, social, or economic situation that you believe will improve your chances for academic success.

Please briefly describe your current career or educational objectives.

List the specific courses you hope to take next term, if you are granted re-entry.

College of Applied Health Sciences Re-Entry Application

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Personal Information

Current Coursework

Please click Save to submit your application with the current information you have entered. Once saved, you will not be able to edit your responses.

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