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.  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 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.
Why were you dropped from classes?*
Have you been attending the course(s) you are requesting to be added back to your schedule?*

Course Section Information #1

Example: MTH 100, ENG101, etc.
Example: 10054

Course Section Information #2

Example: MTH 100, ENG101, etc.
Example: 10054

Course Section Information #3

Example: MTH 100, ENG101, etc.
Example: 10054

Course Section Information #4

Example: MTH 100, ENG101, etc.
Example: 10054

Course Section Information #5

Example: MTH 100, ENG101, etc.
Example: 10054

Course Section Information #6

Example: MTH 100, ENG101, etc.
Example: 10054

Student Aknowledgement Section

I understand that completing this form, 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 non-attendance.  I understand that should I be reinstated back into my class that I am responsible for making up any missed assignments.    

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

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*

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*
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