First Name: M.I.: Last Name:
Address:
Town: State: Zip:
Email: Phone: xxx-xxx-xxxx
Reason for Disenrollment :
Disciplinary Disenrollment
Date of Disenrollment:
Desired Return: Term Fall Semester Spring Semester Cruise Cadet Shipping Co-operative Year: Term Year 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Major at Disenrollment: Major Marine Engineering Operations Marine Engineering Technology Power Engineering Technology Power Engineering Operations Marine Systems Engineering Marine Transportation Operations Small Vessel Operations Small Craft Design Small Craft Systems Marine Biology Marine Science Int'l Business & Logistics Interdisciplinary Studies
Are you intending to pursue the same major upon readmission? Yes No
If NO, what major are you considering? Major Marine Engineering Operations Marine Engineering Technology Marine Systems Engineering Power Engineering Technology Power Engineering Operations Marine Transportation Operations Small Vessel Operations Small Craft Design Small Craft Systems Marine Biology Marine Science Int'l Business & Logistics Interdisciplinary Studies
Note A: If returning from a Leave of Absence of less than one calendar year, submit application for reenrollment now. For all other applicants, please complete the following information.
Letters of Recommendation
I. MMA Faculty and/or Administrator(s) (minimum of 2 required):
1.
2.
II. Employer (please provide the name, address, and phone number):
Company:
Name of reference:
Phone:
III.
Your financial standing must be clarified before your application for readmission can be considered. Have you contacted the MMA Finance Office (207)326-2243? Yes No
Medical History
All students must submit an updated physical examination as a criterion for readmission. Depending on how long you have been out of school, you may be required to have additional immunizations. Should you have additional questions regarding your immunizations, e-mail Sue McDonald, Director of Health Services. You must satisfy all physical and immunization requirements prior to registration.
Have you had a physical examination within the last year? Yes No
Is there any significant changes to your overall health since leaving MMA? Yes No
If YES, please explain in detail:
The application for readmission must be completed by the following dates for consideration:
