Anoka Technical College

Re-Admission Form

Fields marked with an * are required.

Name:*

Maiden Name:*

Anoka Techincal College ID#:*

Date of Birth:*

Permanent Address Number, Street, P.O. Box:*

City:*

State:*

Zip Code:*

Telephone:*

Email:*

Name of State of which you are a legal resident:

Major:*

Semester you wish to re-enter Anoka Tech:

Quarter/Semester that you first attended Anoka Tech:

Quarter/Semester that you last attended Anoka Tech:

Have you attended any other schools since you last attended Anoka Tech?
Yes
No

If yes, please list those schools and the dates attended:

This page last modified: 11/01/2011