9/20
Processed by:______________________________________Date:_____________________
Aft
er reinstated, notify:
□ Student □ Instructor
If
processed after the nonattendance date, notify:
□ Financial Aid
CLASS SCHEDULE REINSTATEMENT FORM
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
Co
urse 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
Inst
ructor Approval:
_______
____________________ should be reinstated in ________________________________________
Student Name CRN & Course Name
I v
erify this student attended the above course on ______________________________
Student’s Date of Attendance
________________________________________________________________ ______________________
Instructor Signature Date
_______
_________________________________
Instructor Email Address
g a d s d e n
s t a t e
c o m m u n i t y c o l l e g e
click to sign
signature
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