Qualtrics Survey | Qualtrics Experience Management

Personal Information:

First name

Last name

Date of Birth (MM/DD/YY)

Laurier ID#

Email Address

Contact Information:

Street Address

City

Province

Country

Postal Code

Phone Number

Have you attended any universities and/or colleges since you were last registered at Laurier?

Yes
No, I have not registered with any universities/colleges since attending Laurier (Failure to disclose degree-level postsecondary study may result in an academic misconduct penalty)

If you attended another university or college since you last registered, did you receive an academic decision of ‘Required to Withdrawal’?

Program requested:

Honours Major/Discipline (excluding general BA):

Returning term:

Status:

I confirm that I have not been registered for at least 18 months at Laurier and left in good standing.

Comments:

Fee Acknowledgement:

As of September 1st 2023, there is a non-refundable fee of $56.00 to request re-registration at Laurier. Once the form is received, you will be contacted via email with instructions on how to pay the fee. Your request will not be processed until the fee has been received. Payment of this fee doesn't guarantee that you will be re-registered. Please note that there are no exemptions from this fee.

Electronic Signature:

By checking this box, I am providing my electronic signature whereby I confirm that the information submitted is accurate and I understand that if I am readmitted, I may return only in the term I applied for. Personal information is collected under the authority of the Wilfrid Laurier University Act and privacy policies to administer the university-student relationship. For more information about how your information is used, collected and shared, visit wlu.ca/privacy.

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