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Extended Education Activation Request Form

Ohio State students requesting either a program change to undergraduate nondegree or a return from leave of absence should complete this form. Upon submission, your request should be processed within 2-3 business days.

If you have any questions, please contact Extended Education at otdi-extendeded@osu.edu.

1. Please provide the following information:

First name

Last name

Email

Phone number
(include area code)

Date of birth
(mm/dd/yyyy)

2. Have you used any other name (such as a maiden name) that is different than the one you identified above?

Yes

No

2a. If you have used another name(s), please specify below.

3. Please indicate your previous status at The Ohio State University.

Former degree seeking student requesting a program/major change to undergraduate non-degree.
Former Extended Education non-degree student requesting a return from leave of absence.

4. What is the most recent academic term that you attended The Ohio State University?

Autumn

Winter

Spring

Summer

5. What is your most recent year of enrollment at The Ohio State University?

6. The following information is not required, but may help us with locating your Ohio State records.

OSU Name.#

OSU ID
(8 or 9 digit number)

SSN (last 4 digits)

7. What is your permanent address?

Address

City

State/Country

Postal Code

8. Is the address you identified above different from your home/current address?

Yes

No

8a. What is your home/current address?

Address

City

State/Country

Postal code

9. Who should we notify in case of an emergency?

Full name

Address

City

State/Country

Postal code

Phone number
(include area code)

10. Which best describes your relationship to the person that you identified above?

This person is my...

11. Identify the academic term for which you are applying.

Autumn

Spring

Summer

12. Specify the year for which you are applying.

14. Are you planning on taking prerequisite coursework to gain entry into a program that leads to an undergraduate, graduate, or professional degree at Ohio State?

Yes

No

15. If you are planning to take preparatory courses to prepare for a future area of study, select the area of study that most closely matches your future plans.