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Undergraduate Reactivation Form

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*Required Fields

Student I.D. (If Known): First 9 Digits on Your All Card

Social Security Number*

*For Social Security Number, if you are an international student please enter 000000000.

First Name*

Last Name*

Middle Name

Previous Last Name

Email Address*

Birthdate*

Birthdate*

Requesting reactivation for the following term*

Reason for leaving Xavier*

Program declared when last enrolled at Xavier*

Would you like to stay as this program?*

Would you like to stay as this program?*

Yes

No

What program are you intending on changing to if you are reactivated?

Have you attended other colleges or universities since leaving Xavier?*

Have you attended other colleges or universities since leaving Xavier?*

Yes

No

**If yes, send official transcript to: Xavier University, c/o Office of the Registrar, 3800 Victory Pky., Cincinnati OH 45207-3351
NOTE: All future registration will be restricted until transcripts are received.

Permanent Information*

Permanent Address*

Permanent Address*

Country

Street

City

Region

Postal Code

Permanent Phone

Local Information

Local Address

Local Address

Country

Street

City

Region

Postal Code

Local Phone

Student's Portal ID