Request to Return

If you previously were enrolled at Herkimer College and would like to be considered for readmission, submit this request form.

By submitting this request you certify that the information provided is correct. False information or omission of data may result in denial of your request.

First Name

Last Name

Birthdate

Herkimer College ID or last 4 digits of SS#

Mailing Address

Country

Street

City

Region

Postal Code

Phone Number

Email Address

Preferred Contact Method

Email

Phone

Have you attended another college since leaving Herkimer?

Yes

No

Have you ever been dismissed from another college for disciplinary reasons?

Yes

No

I'd like to:

Pursue a degree or certificate program

Pursue a microcredential

Take just a few classes (no degree or financial aid)

Please indicate your intended program of study. If you are unsure, please leave blank.

Please indicate the microcredential you are interested in:

In accordance with the State University of New York’s policy regarding the admission of persons with prior felony convictions (Policy #3200), Herkimer College is required to inquire if a student has a prior felony conviction if the student seeks participation in clinical, field experiences, or internships.

Yes, I have been convicted of a felony in my lifetime.

No, I have NOT been convicted of a felony in my lifetime.

I understand my financial aid eligibility is independent of academics. To determine eligibility I will need to work with the Financial Aid Office.