Status Reactivation Application
Last Name
First Name
Middle Initial
Personal Email Address
Previous/Maiden Name
Campus Wide ID (CWID)
Phone Number
Address
Apt #
City
State
Zip Code
Country
Date of Birth
Marital Status
Married
Not Married
Title
Mr.
Ms.
Sex
Male
Female
US Citizen
Yes
No
Type of Visa
F-1
B-2
J-1
PRV (Green Card)
Other
Please Specify Visa Type
Country of Citizenship
Major/Program
(BSMGMT) BS in Management
(MBFEMBA) Business Management
(MBMBAJ) Business Management
(MSAA) MS in Business Analytics
(MSHRFE) MS in Human Resources
(MSMGTLEAD) MS in Management & Leadership
(PGRDMBA) Postgraduate
Online MBA
Degree
Graduate
Undergraduate
Expected Graduation Year
Expected Graduation Term
Fall (December)
Spring (April)
Summer (August)
Year Last Attended
Term Last Attended
Fall (August)
Spring (January)
Summer (April/May)
Year to Re-Enroll
Term to Re-Enroll
Fall (August)
Spring (January)
Summer (April/May)
Preferred Campus Location
Irvine
West Los Angeles
Calabasas
Online
Has any college dismissed you or asked you to withdraw?
No
Yes
Please explain below
Please list all colleges attended since leaving Pepperdine University. Official transcripts must be sent directly from all institutions listed to the Office of the University Registrar at Pepperdine University. Please indicate number of units currently in progress.
Add College
Remove College
Employer
Position/Title
Employer Address
City
State
Zip Code
Work Phone
