Request to Return

First Name

Last Name

Email Address

Birthdate

Present Address

Country
Street
City
Region
Postal Code

Is your home address different than your present address?

Yes

Home Address

Country
Street
City
Region
Postal Code

Home Phone

Cell Phone

Gender

Female

Male

Marital Status

Social Security Number (omit dashes)

When do you plan to return?

Housing Preference

Key:
*Concentration
%Focus area
~Required Minor
+Pre-Professional Track
>Pending New York State Approval

Academic Major

Primary Instrument

Do you have a second major?

Yes

Academic Major

Primary Instrument

What are your reasons for requesting to return?

Have you attended another college since you last left Houghton?

Yes

College Name 1

College Name 2

Because you mentioned attending a school since your time at Houghton, we will need that transcript before your form can be evaluated by an admission committee. After you've submitted this form, please then also request the needed transcript.

If a semester or more has elapsed since you last attended school, how have you spent your time?

Have you been subject to disciplinary action or a disciplinary hearing for any reason at any college, including Houghton?

Yes

If yes, please explain

Explain why you desire to return to a college community that pursues both academic excellence and spiritual development as part of the education process

Acknowledgement of Community Covenant

In returning to the Houghton College community, I voluntarily covenant with God and with other members of our community to live with integrity and discernment according to the provisions of the Community Covenant. The Community Covenant can be found here: www.houghton.edu/covenant.

We covenant together as a Christian learning community:

To pursue academic achievement, personal development and spiritual growth.
To create an educational environment that integrates faith, learning and living in a way that honors Christ, follows biblical principles, builds loving relationships, and develops whole persons who will be active in serving Christ.
To adopt community-wide behavioral standards, as outlined in the Community Covenant, promoting an alcohol-free, tobacco-free and drug-free environment.

Signature

Date