Division of Graduate Studies

Application for Graduate Second Chance

SECTION I:  Personal Information

Date of Application        

Full Name

                        Last,                                                First                                                    Middle

e-mail address: 

                                                                                                                             

J Number:  J          Social Security Number 

 Telephone:  Home/Cell     Work

----------------------------------------------------------------------------------------------------------------------------

SECTION II:  Academic Information

Date of Last Enrollment at JSU:


Degree:


Major:

Desired Enrollment Semester:  Fall       Spring        Summer       Year 20

----------------------------------------------------------------------------------------------------------------------------

SECTION III:   Please include an academic enhancement plan (AEP) with a signature from your advisor.
Failure to mee the academic requirements of the AEP will  result in a permanent dismissal.

I certify the information supplied is correct and complete.

Signature: ___________________________________                         Date: _________________________

----------------------------------------------------------------------------------------------------------------------------

SECTION IV:  APPROVALS   We have reviewed the requirements of the department/program.(Please sign and date). (Please attach a current "JSU Transcript".)


Major
Advisor: _________________________________________

Type Name:  

 Approved     Denied (list reason)

Comments_______________________________________

___________________________________________________

.
Department Chair/
Program Director: _______________________________________
 

Type Name:

  Approved     Denied (list reason)

Comments_______________________________________

___________________________________________________

.

Academic Dean: _______________________________________

Type Name:   

 Approved     Denied (list reason)

Comments_______________________________________

___________________________________________________

 For the Division of Graduate Studies 

.

.

_________________________________________________

Name/Date

Approved     Denied (list reason)

Comments_______________________________________

___________________________________________________

Processed by the Registrar  _________________________

                                                         Name/Date

 

SECTION V:  Academic Review:  Courses to Transfer from Academic History to New Academic Program

Dept.

No

Title

Sem. Hrs.

Grade

Semester