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 | Application for Re-activation
 | [NAME]
 | All responses must be printed or typed.
1 | FULL Legal Name:
 |  |  |  |  |  |  |  |  |  |  |  | PREFIX |  |  |  | LAST |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FIRST AND MIDDLE |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SUFFIX
 | Preferred Name(s):
 | Any other name(s) under which your documents might be received:
2 | Social Security Number: |  |  |  |  |  |  |  |  |  |  |  |  |  | – |  |  | – |  |  |  |  |  |  | 3 | If you're a Non-Immigrant, what is your current visa status?
4 | Residence Address:
 | (Current Mailing Address) |  |  |  |  |  |  |  |  |  |  | STREET AND NUMBER
 |  |  |  |  |  |  |  |  |  |  |  | CITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | STATE/COUNTRY |  |  |  |  |  | ZIP CODE
5 | Permanent Address:
 | (If Different from Above) |  |  |  |  |  |  |  |  |  |  | STREET AND NUMBER
 |  |  |  |  |  |  |  |  |  |  |  | CITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | STATE/COUNTRY |  |  |  |  |  | ZIP CODE
6 | Business Address:
 |  |  |  |  |  |  |  |  |  |  |  | STREET AND NUMBER
 |  |  |  |  |  |  |  |  |  |  |  | CITY |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | STATE/COUNTRY |  |  |  |  |  | ZIP CODE
7 | Contact Information: |  |  |  |  |  |  |  |  |  |  |  |  |  | – |  |  |  | – |  |  |  |  |  |  |  |  |  |  | – |  |  |  | – |  |  |  |  |  |  |  |  |  |  | – |  |  |  | –
 |  |  |  |  |  |  |  |  |  |  |  | RESIDENCE |  |  |  |  |  |  |  |  |  |  |  |  |  |  | BUSINESS |  |  |  |  |  |  |  |  |  |  |  |  |  |  | FAX
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | @ |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q Personal
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q Business
 |  |  |  |  |  |  |  |  |  |  |  | E-MAIL ADDRESS
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q School
8 | Desired Returning Semester and Status: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q | Fall |  |  | q | Spring |  |  |  | q | Summer |  |  |  |  |  |  |  |  |  | q | Full-time |  |  |  |  | q | Part-time
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | YEAR
9 | Desired Source of Study: |  |  |  |  |  |  |  |  |  |  | q | Main-Campus |  |  |  |  |  | q | Distance Education
10 | Are you currently on suspension from SMU?  If so, please attach a statement petitioning for re-admission into the Graduate Division of the [NAME]
 | School of Enginering
11 | Please indicate your last semester of attendance in the Bobby B. Lyle School of Engineering: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q | Fall |  |  | q | Spring |  |  |  | q | Summer
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | YEAR
12 | Criminal History:
 | [NAME] you currently under indictment for any crime? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q | Yes |  | q | No
 | [NAME] you ever been convicted of, pleaded guilty to, or received, deferred adjudication for any felony, state jail felony,
 | or Class A misdemeanor? |  |  |  |  |  |  |  |  |  |  |  | q | Yes |  | q | No
 | [NAME] you ever received, or are you currently on probation? |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | q | Yes |  | q | No
 | (Disclosure in the affirmative will not necessarily result in rejection of an applicant for admission.  Failure to disclose such a record, if it exists, and to explain that record honestly,
 | however, may result in your dismissal from the University.  Failure to explain an affirmative response to this question will result in the Application's not being further processed).
13 | Have you ever been dismissed or suspended from, or denied admission to, any school, college or university, or graduate school?
 | If so, please explain on a separate page.
14 | I certify that all statements made in this application for re-activation to the graduate program at the Bobby B. Lyle School of Engineering are correct to the best of my knowledge.  I realize that all documents submitted in support of this application become the property of SMU.  I understand and agree that any misrepresentation or omission of facts in my application will justify the denial of admission or the cancellation of admission.
 | (a) |  | Date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | (b) |  | Signature:
 | INSTRUCTIONS:
1 | Please fill out all applicable blanks on the application form using a typewriter or block print and return to Graduate Admissions at the address below:
 |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  | [NAME] of Engineering
 |  |  |  |  |  |  | Southern Methodist University
 |  |  |  |  |  |  | PO Box 750335
 |  |  |  |  |  |  | Dallas, TX  75275-0335
2 | If you have previously attended SMU under a different name or ID, you must furnish to the Registrar a copy of the legal document changing your name and a photocopy of your Social Security card.
3 | This application should be sent to the Graduate Division by July 1 for Fall admission; November 15 for Spring admission; and April 15 for Summer admission.
 | SMU will not discriminate in any employment practice, education program, or educational activity on the basis of race, color, religion, national origin, sex, age, disability, or veteran status.  SMU’s commitment to equal opportunity includes nondiscrimination on the basis of sexual orientation.                                                                 Nov 08