Midland Lutheran Admissions - Application for Re-Admission

Application for Re-Admission

Personal Information

Please complete this application if you have spoken with your Admissions Counselor. If you have not spoken with a counselor, please call the Admissions Office at 402.941.6501.

First Name:

Middle Name:

Last Name:

Mailing Address:

City:

State:

ZIP Code

Preferred Phone:

Email:

Date of Birth:

Academic Information

Degree Track:

Intended Field of Study:

Reason(s) for leaving Midland Lutheran College:

Reason(s) for wishing to return:

Please describe your professional and/or personal accomplishments since leaving MLC (such as jobs held, marriage, family, etc.):

Have you earned college credits since your departure from MLC?

Yes
No

If yes, from which institutions?

If you have attended any colleges or universities since you last attended MLC, have all official transcripts sent to the Registrar’s Office at 900 N. Clarkson, Fremont, NE 68025.

Certification

By checking the box below, I certify that I have read this form and that all information furnished is complete and correct to the best of my knowledge.

Certification: