Application for Returning Students Life is unpredictable. It is not unusual to take a break before finishing a degree program. You’re not alone. We can get you back on track! This application is intended for Ph.D. students who have been absent from the program for at least a full calendar year and would like to re-enroll. This form will guide you through: Updating your records and adding additional transfer credit, if applicable. Confirming your degree choice. Providing the necessary forms for re-admission. Determining a reasonable re-entry date. In addition to this form, you will be asked to submit a current résumé and a paragraph or two describing your rationale for returning to the program. Required fields are denoted by (*).Personal InfoFirst Name*Middle InitialLast Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country County of ResidencePhone*Phone Type*CellHomeWorkOtherSecondary PhoneSecondary Phone TypeCellHomeWorkOtherEmail* Legal Gender*MaleFemaleLegal gender is required for federal reporting purposes.Date of Birth* Date Format: MM slash DD slash YYYY Returning InformationName While Attending*Date of Last Attendance*Preferred Re-Entry Date*Fall - Semester 1 (August)Fall - Semester 2 (October)Spring - Semester 1 (January)Spring - Semester 2 (March)Summer - Semester 1 (May)Summer - Semester 2 (July)Please confirm your desired area of concentration.*Organizational ManagementAcademic AdministrationAdditional EducationHave you attended any other college or university since you lasted attended Indiana Tech? If so, please tell us about it below.University NameStateGraduation YearDegree EarnedMajorGPANote: A complete official transcript from the above college or university must be received by Indiana Tech before final approval for readmission.If you would like this additional credit to be considered for transfer, have you requested the corresponding transcript be sent to Indiana Tech?*YesNoNot ApplicablePlease mail your transcripts to the following address: Ph.D. Program Indiana Tech 1600 E. Washington Blvd. Fort Wayne, IN 46803 Or, have them sent electronically by the awarding university to phd@indianatech.edu. Additional Application MaterialsPlease submit a current résumé including educational record, employment history, and relevant accomplishments, publications, presentations, and professional contributions.Current Résumé*Accepted file types: pdf.*PDF format onlyRationale for Returning*Please provide a paragraph or two describing your rationale for returning to the program. Feel free to tell us about any accomplishments or academic/professional progress made during your absence or any new educational goals that may have emerged.CommentsPlease specify any additional comments or clarifications related to your application.Payment OptionsEach Ph.D. student must select a payment option. This gives the Business Office the information needed to process your tuition account. View a description of each option. Select a payment option*Pre-payFinancial AidVoucher/Authorization Form ProcessDirect BillingDeferment for Employer Assistance ($25 fee per year)MilitaryDate FAFSA filed* Date Format: MM slash DD slash YYYY Employer phone number*Employer contact name*Benefit type*PoliciesPlease read the information carefully. After reading, check the boxes to confirm that you understand the policies.Non-Discrimination Policy Indiana Tech admits students without regard to race, color, national or ethnic origin, or disability to all rights, privileges, programs, and activities generally accorded to or made available to students at the school. Indiana Tech does not discriminate on the basis of race, color, national or ethnic origin, or disability in administration of its educational policies, admissions policies, scholarship, loan programs and athletic and other school administered programs. Indiana Tech will make reasonable accommodations for qualified individuals with a disability so that such individuals can enjoy the same access to services, programs or activities as other non-disabled individuals.Acknowledgment* I have read and acknowledged the Indiana Tech Non-Discrimination Policy. Possible Re-Entry Interview I acknowledge that the completion of this form does not imply automatic re-entry into Indiana Tech's Ph.D. program. I recognize I might be asked for additional information or asked to interview with the Program Director prior to re-entry.Acknowledgment* I acknowledge the possibility of a Re-Entry Interview. Indiana Tech Verification Agreement I do hereby certify that all the information listed on this application is, to the best of my knowledge, accurate and truthful.Acknowledgment* I have read and agreed to the Indiana Tech Verification Agreement. Initials*