Jan 2020
Records Office
Processed by:______________________________________Date:_____________________
After reinstated, notify:
□ Student □ Instructor
If processed after the nonattendance date, notify:
□ Financial Aid □Business Office
Students with courses dropped for non-payment or removed for non-attendance can request
reinstatement of the original course schedule as verified on a registration audit history. New courses
cannot be added as part of the reinstatement process. Each course must have an available seat.
This form must be completed by both the student and instructor and submitted to the Records office for
reinstatement. Forms may be emailed from the student to instructor for signature. Completed forms may be
emailed to records@gadsdenstate.edu
for processing.
__________________________________ ______________________ ____________________
Student Name Student ID Term
Course to reinstate:
___________ _______________________
CRN Course Name
By signing, I acknowledge I am responsible for any and all charges incurred by this schedule reinstatement regardless of financial
aid status.
________________________________________________________________ ______________________
Student Signature Date
Instructor Approval:
___________________________ should be reinstated in ________________________________________.
Student Name CRN & Course Name
I verify this student attended the above course on ______________________________.
Student’s Date of Attendance
________________________________________________________________ ______________________
Instructor Signature Date
Instructor Email Address
click to sign
click to edit
click to sign
click to edit