Name: OSU Student ID:
Email: Telephone (area code and number):
Address for reply:
I request reinstatement for Semester, 20 .
SU/AU/SP
I was last enrolled in (college/major):
If reinstated, I am planning to major in:
Since your dismissal from Ohio State, have you been suspended or dismissed from any other college or university for any
disciplinary reason, or is a disciplinary charge from any college or university currently pending against you?
Yes _____ No _____ (If yes, please explain. Additional information may be requested.)
Since your dismissal from Ohio State, have you been suspended or dismissed from any other college or university for any
academic reason, or is an academic charge from any college or university currently pending against you?
Yes _____ No _____ (If yes, please explain. Additional information may be requested.)
Student Signature: Date:
Petition Questions (attach clear/complete typed responses to the following):
1. What behaviors or conditions contributed to your dismissal from The Ohio State University?
2. What have you been doing, in general and academically, since your dismissal? How has this helped prepare you for a
successful return to Ohio State?
3. What adjustments have you made, or will you make which you believe will eliminate conditions that contributed to your
dismissal? What evidence can you provide that, if reinstated, you will be a successful student with significantly better
academic performance (courses completed, tutoring, work experience, etc.)? Submit with the petition evaluation reports
from instructors or tutors or enclose grade reports of courses completed.
4. What are your academic and career goals? Describe how this aligns with your proposed area of study.
5. How will you finance your education if reinstated? If you will be working, discuss the number of hours and the nature
of your work.
Please Note: Students returning from Academic Dismissal are not eligible to receive Financial Aid. They may appeal
to have it reinstated. Appeal forms are available at http://sfa.osu.edu/contact-us/forms.
6. Present any additional information that will indicate probable academic success or that will be helpful to the Committee
in reaching a decision on your petition.
Office Use Only
Committee Action Taken: _____ Approved _____ Not Approved for ________________Semester, 20______
Special conditions (point-hour, work, courses, counseling, activities, etc.):
Committee Member: __________________________________________ Date: ______________
