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Request to Return

Request to Return

We’re glad you’re back!

If you previously were enrolled at Herkimer College and would like to be considered for readmission, submit this request form. We will contact you within 48 hours with next steps.

*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 ^*

Former Name

Herkimer College ID or last 4 digits of SS# ^*

Date of Birth ^*

Street Address (with apartment number if applicable) ^*

City ^*

State ^*

Zip Code ^*

Phone Number

Email Address ^*

Preferred Contact Method ^*

Phone

Have you attended another college since leaving Herkimer? ^*

Yes

Why did you leave Herkimer? ^*

Why do you want to return to Herkimer? ^*