Fields marked with a * are required.

First Name: *
Middle Name:
(If not applicable, enter n/a)
Last Name: *  
Address Line 1:
(No. & Street, P.O. Box, etc.)
Address Line 2:
(Apt., Unit, Block, etc.)
City: *  
State: *
Zip: *  
Country: *  
Home Phone: *  
Work Phone:
Email Address: *
PBA Student ID#:
Social Security Number:
(If international applicant and not applicable, enter n/a)
Date of Birth: (mm/dd/yyyy)
Date of last attendance to PBA: (mm/yyyy)
Have you attended another college since you left PBA? *
Receiving VA benefits? *
Have you previously earned a degree from PBA? *
Requesting Student Visa (F-1)? *
Do you plan to earn a degree at PBA? *
Will you be applying for financial aid? *  
Do you desire on-campus housing? *  
Have you ever been arrested or convicted of a misdemeanor or felony other than a minor traffic violation? *  
Date you plan to re-enter PBA: *  
Expected Status: *  
PBA Campus you plan to attend: *  
Please respond to each statement in the space provided. These short essays will further assist the Readmission Review Committee.

1. Please write a 250-500 word statement detailing several reasons why you should be readmitted to PBA. Be sure to briefly comment on your academic and/or professional plans.


2. Please write a 250-500 word statement providing an objective outlook or outline of your specific goals for attaining academic success at PBA.

By entering your initials below, you certify that you have given full and complete information in this application and have listed all schools and/or colleges you have attended since you were last enrolled in PBA.

Enter your initials: