Course Reinstatement Request

Course Reinstatement Request
Use this form to request reinstatement into a course after you have been removed for nonattendance. You must have started attending or participating in the course, and your instructor must approve the request. If approved, the request will be sent to the Registrar’s Office for processing. Reinstatement is not guaranteed.
Name

First NameLast Name
LoLA Number
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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.
Date

MonthDayYear
Date
Registrar's Office
Processed by:
Date

MonthDayYear
Date
Comments
Should be Empty:

Registrar's Office