Reinstatement After Purge

The Reinstatement period for Spring 2025 will end Monday, January 20, 2025 at 6:00pm.

Date

I acknowledge that this form is only for reinstatement for NON-PAYMENT and is not for no-shows.*

Yes

Student Name*

First NameLast Name

Student Email*

Student ID#*

How many courses do you wish to be reinstated? *

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1
2

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1
2
3

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1
2
3
4

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1
2
3
4
5

Course Information *

	CRN	Course Name/Number ex:ENGL 1101	Credit Hours	Last Date Attended
1
2
3
4
5
6

I understand the courses listed above are the only courses in which I wish to be reinstated.*

Yes

Comments: (If additional information is needed about student or course, enter it here.)

Are you receiving third party payments, such as WIOA, Veterans, or local scholarships?*

YesNo

Verified by Registrar's Office:*

YesNot eligible for Reinstatement

Does the student have Financial Aid?

YesNo

Amount of Financial Aid available

Financial Aid Verifier

First NameLast Name

Date

Financial Aid Comments

Does student have a balance due?

YesNo

Amount Owed

Cashier Verifier

First NameLast Name

Date

Cashier Comments

Status

ReinstatedNot Reinstated

Reinstatement Date

Date

Reinstated by

First NameLast Name

Thirty days after the first day of class, if the student has not paid, the form should be marked NOT REINSTATED and the workflow terminated.

Registrar Comments

Reinstatement After Purge

Student Information

Registrar Approval

TO BE COMPLETED BY FINANCIAL AID

TO BE COMPLETED BY CASHIER

TO BE COMPLETED BY REGISTRAR'S OFFICE