Course Reinstatement Request

Course Reinstatement Request
A student who is purged from a class due to non-attendance may be reinstated into the class with the instructor’s approval if the student has since started attending the class. Student is to complete and submit this form to obtain the instructor’s permission. After the reinstatement request is approved, the instructor will submit the request to the Registrar’s Office.
Name*

First NameLast Name
LoLA Number*
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Instructor*
Instructor's Email*
example@example.com
CRN*
Course*
Section*
Reason(s) you are requesting to be reinstated:*
By signing and submitting this form, you acknowledge that your electronic signature is the is the legally binding equivalent to your handwritten signature. By submitting this form, you are hereby requesting to be reinstated in the course/credit hours entered above.*

Clear
Date*

MonthDayYear
Date
Should be Empty: