Application for Readmission

Last Name*

First Name*

M.I.

Date of Birth*

Address*

Street Address City State ZIP Code

Email*

Phone*

Reason for Disenrollment*

Leave of Absence
Resignation
Academic Disenrollment
Graduation
Disciplinary Disenrollment

Date of Disenrollment*

List the college/institution where you have been enrolled in college courses:*

Has an official transcript been sent to Admisisons?*

Yes
No

Have you ever been suspended, placed on probation, or been dismissed from any school for any academic or disciplinary reasons or incurred other formal disciplinary action?*

Yes
No

Have you ever been convicted of a crime or are you currently involved in a criminal proceeding?*

Yes
No

If you answered yes to either or both of the above questions, explain the circumstances in detail.*

Desired Return*

Fall Semester
Spring Semester
Cruise
Cadet Shipping
Co-operative

Major at Disenrollment*

Are you intending to pursue the same major upon readmission?*

Yes
No

If NO, what major are you considering?*

Letters of Recommendation

Letters of recommendation should be written by MMA Faculty and/or Administrator(s). (minimum of two required)

Names of faculty/staff submitting letters of recommendation (from MMA) #1*

Names of faculty/staff submitting letters of recommendation (from MMA) #2*

Employer Reference

Please provide the name, address, and phone number of your current or most recent employer.

Employer Name*

Employer Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Employer Email*

Employer Phone*

Financial Standing

Your financial standing must be clarified before your application for readmission can be considered.

Have you contacted the MMA Finance Office 207-326-2243?*

Yes
No

Medical History

All students must submit an updated physical examination as a criterion for readmission. Depending on how long you have been out of school, you may be required to have additional immunizations. Should you have additional questions regarding your immunizations, contact Tammy Tyler, Director of Health Services at 207-326-2295. You must satisfy all physical and immunization requirements prior to registration.

Have you had a physical examination within the last year?*