Welcome to the New Reinstatement Request Form

This form should ONLY be completed if you can show documented evidence that you are completed the following tasks in the course or have extenuating circumstances approval:

1. Submitted at least one assignment in the course
2. Have documentation of graded or submitted assignment (uploaded screenshot, picture, .pdf required)
3. Extenuating Circumstances documentation (must be approved by the Vice President of Instructional Services, contact 205.929.2015 or bcrawford@lawsonstate.edu)

If you cannot provide the above required items, YOU CANNOT BE REINSTATED and SHOULD NOT COMPLETE THIS FORM. You are strongly encouraged to register for the same course or a replacement course in our upcoming term. Program advisors/counselors will be available to assist you with identifying another course.

Student Class No Show Reinstatement Request Form


This form should be completed by students that are attempting to re-register for courses after being dropped from their course(s) for non-attendance/lack of engagement in the course (no submitted assignment).  Students must complete a Class Reinstatement Request Form for each course he or she wishes to re-enroll.  New courses cannot be added as part of the reinstatement process.  Reinstatement may be granted only with instructor, Dean or VP's approval.

Student Information Section

Student Name*
Semester / Term*
What method of payment was used to pay for reinstated course? (Check all that apply)*
How many courses are you requesting to be reinstated?*
Indicate how many courses you will to get added back that was dropped.
Have you submitted at least one assignment for the course you wish to be added back to your schedule or have documented approval for extenuating circumstances from VP of Instructional Services?*

Course Section Information #1

Example: MTH 100, ENG101, etc.
Example: 10054
Upload documentation of 1st assignment ( Note: This can be picture, screenshot, pdf, etc...)
No File Chosen
File uploads may not work on some mobile devices.
Is this a GROUND, ONLINE, VIRTUAL or HYBRID class #1?*
How is the class being taught?
Have you physically attended the course #1 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hybrid class?*

Course Section Information #2

Example: MTH 100, ENG101, etc.
Example: 10054
File
No File Chosen
File uploads may not work on some mobile devices.
Is this a GROUND, ONLINE, VIRTUAL or HYBRID class #2?*
Have you physically attended the course #2 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hyb class? *

Course Section Information #3

Example: MTH 100, ENG101, etc.
Example: 10054
File
No File Chosen
File uploads may not work on some mobile devices.
Is this cla GROUND, ONLINE, VIRTUAL or HYBRID class #3? *
Have you physically attended the course #3 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hybrid class??*

Course Section Information #4

Example: MTH 100, ENG101, etc.
Example: 10054
File
No File Chosen
File uploads may not work on some mobile devices.
Is this a GROUND, ONLINE, VIRTUAL or HYBRID class #4?*
Have you physically attended the course #4 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hybrid class??*

Course Section Information #5

Example: MTH 100, ENG101, etc.
Example: 10054
File
No File Chosen
File uploads may not work on some mobile devices.
Is this a GROUND, ONLINE, VIRTUAL or HYBRID class #5?*
Have you physically attended the course #5 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hybrid class?? *

Course Section Information #6

Example: MTH 100, ENG101, etc.
Example: 10054
File
No File Chosen
File uploads may not work on some mobile devices.
Is this a GROUND, ONLINE, VIRTUAL or HYBRID class #6? *
Have you physically attended the course #6 if ground class or attended virtually (zoom or blackboard collaborate) if virtual/hybrid class?? *

Student Acknowledgement Section

I understand that completing this form along with documentation, does not guarantee that I will be reinstated in my courses.  I also understand that the instructor reserves the right to deny reinstatement due to lack of attendance/lack of engagement in course (no assignment submitted).  

I also understand that should I be reinstated back into my class(es) that I am responsible for payment, missed work assignment participation and that I must request withdrawal should I decide not to continue in the course.

Date/Time*
Use your mouse or finger to draw your signature above

Record's Office Approval

Review the comments in the Financial Aid section to see which classes have had attendance verified and if the balance owed has been paid.  If there is no amount due, proceed to register the student back into the classes with a status of "RE".  Insert the last date of attendance for these classes, sign and submit this form.  Verify that the correct classes have been reinstated with a status of "RE", and the student's last date of attendance has been updated for the classes listed above by Financial Aid before signing.

RO - Approved/Denied*

Financial Aid Approval

Approval should only be granted after verifying the full payment method of payment (pell grant, scholarships, VA, etc) of the student who is being re-instated.

FA - Approval/Denied*
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