Academic Reinstatement Appeal Form

Complete the form below to apply for Academic Reinstatement. Please provide complete answers for all questions. Documentation to support mitigating circumstances can be uploaded below.

Student ID (EMPLID):

Date of Birth

Student Name:

Email Address:

Phone Number:

I would like to be reinstated for:

Fall SpringSummer

Year

Have you appealed to this committee before?

YesNo

Briefly describe the circumstances leading to your ineligibility:

Describe your career objective(s):

What would be different for the next semester if granted approval?

What systems for success have you developed for the next semester?

Why do you feel that immediate reinstatement is necessary?

Upload Documentation Here

By typing your name below, you acknowledge that you have: 1. reviewed the Academic Reinstatement policy, and 2. provided complete and factual information regarding your appeal Type Full Name Here

Contact Information