Champlain College Readmission Form
Dashboard Champlain College Traditional Student Re-enrollment Form

General Information        (* = required)

Name: (First, Middle, Last) *
Former Name(s), if applicable:
Address: * Street: City: State: Zip: Type:
Phone Number: * Invalid format. Type:
Email Address: * Invalid format.
Birth Date: * Invalid format (mm/dd/yyyy).
College ID:

Academic Plans

Last attended Champlain: * Semester:  Year:
What were the reasons for your leaving Champlain?

Academic Dismissal   Disciplinary Action   Study Abroad   Transferred


Intended term to return: *
I plan to attend: * Full-time   Part-time and live:
In what major were you previously enrolled?
What major do you wish to enroll now? *
Have you attended other colleges or universities since leaving Champlain? * Yes No
Are you a U.S.
citizen? *
Have you been convicted of a
felony? *
Yes   No
Have you been expelled and/or dismissed from a college or university for disciplinary reasons? * Yes   No

Will you be applying for Financial Aid? *

Yes   No  


I certify that to the best of my knowledge the information given in this application is accurate and complete.

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