This form is for undergraduate student use only. Students who have not been enrolled at NAU for three consecutive terms (summer & winter terms excluded) must complete this form. There is an additional requirement if you were academically suspended from NAU. You must also submit a “Reinstatement Appeal Form” by the published deadlines through the GatewayStudentSuccessCenter. You can find the form on-line at: For questions regarding the reinstatement appeal form, contact the Gateway at or phone 928-523-4772. For assistance determining your enrollment history, and determining whether or not you have to apply for readmission, contact the Office of the Registrar at (928)523-2109.
Returning Term: ______Year: _____ Campus: ______Intended Major:______
Student Information
Last Name: ______First Name: ______Birth Date: ______
Former Name: ______
*Social Security #______E-Mail Address ______Dates Attended:______
(*While it is not required to supply us with your Social Security Number, it assists to quickly and more accurately identify you in our Student Information database. SSN’s are handled in the strictest confidentiality.)
Address: ______
Street City State Zip
Phone: ______□ Check here if you have no phone
Emergency Contact: Name: ______
Day Phone: ______Evening Phone: ______Cell:______
ResidencyAll applicants must complete this section. Your residency classification is your status as of the date of application. Failure to answer any question in this section will result in a classification of non-resident. (Put N/A if not applicable.) Additional verification and/or supporting documentation may be requested of the applicant if the answers to questions in the following section present an unclear and/or unconvincing representation of residency in the state of Arizona. Residency policies are subject to change without notice.
Are you a U.S. Citizen? □ Yes □ No
If you are applying as an international student, please apply through our International Admissions site at:
Please Note: In accordance with Arizona law, any person who is a citizen or legal resident of the US or who is lawfully present in the US may be eligible for specified financial aid from the university. Arizona law classifies any person who is a US citizen or who has lawful immigration status and is an Arizona resident as an in-state student for tuition purposes. Please visit for more information.
Do you consider yourself a resident of Arizona? □ Yes □ No
When did you start residing in Arizona (month and year)? : ______
Driver’s License: State: ______Number: ______Date Issued: ______
Do you own a motor vehicle? □Yes □ No State Registered: ______Original Registration Date: ______
Are you entirely self supporting? □ Yes □ No
If yes, do you file an Arizona income tax return as an Arizona resident? □ Yes □ No
If yes, when was the last filing year? ______
If no, have you filed a tax return in a state other than Arizona? □ Yes □ No
Residency continued…
If you are a dependent, are your parents or guardians residents of Arizona? □ Yes □ No
Does either parent or your guardian file an Arizona income tax return as an Arizona resident? □ Yes □ No
Do your parents or guardians maintain a driver’s license or vehicle registration in a state other than Arizona? □Yes □ No
Have you been honorably discharged from an Arizona military base? □ Yes □ No
Are you, either of your parents or spouse on active duty stationed outside of Arizona and claim Arizona residency? □ Yes □ No
Are you, either of your parents or spouse on active duty stationed in Arizona on military orders, or a member of the Arizona National Guard, or a member of a Reserve unit based in Arizona? □ Yes □ No
Are you an enrolled member of a Native American Indian Tribe of Arizona (that may also extend into another state)? □ Yes □ No
If yes, which tribe? ______Enrollment Card/Certificate of Indian Blood (CIB) number______
The reservation you reside on is located: □ 100% in Arizona □ Partially in Arizona
Armed Forces Affiliation
Please select the one most appropriate answer regarding your United States Armed Forces Affiliation:
□ Currently on Active duty
□ Veteran
□ Spouse or child of veteran and plan to use GI Bill educational benefits
□ Armed Forces Reserves
□ National Guard
□ No Affiliation
Academic Information
List all colleges and universities attended since you were last enrolled at Northern Arizona University:
College/University / Location / Dates Attended / Degree(s)Please have the college(s) you attended send an official transcript of your academic record to the Office of Undergraduate Admissions and Orientation, Northern Arizona University, PO Box 4084, Flagstaff AZ 86011-4084.
Please Read and Sign
I understand that readmission granted on the basis of this application is void if the information given is not true and correct. I understand that readmission cannot be completed until all registration and financial holds are cleared. I agree to observe all the rules and regulations of Northern Arizona University.
SIGNATURE OF APPLICANT: ______Date: ______