COLUMBUS STATE COMMUNITY COLLEGE
PETITION FOR ACADEMIC READMISSION
MUST BE COMPLETED 60 DAYS PRIOR TO THE START OF THE SEMESTER FOR WHICH YOU SEEK READMISSION
PLEASE PRINT LEGIBLY AND COMPLETE THE GRAY SECTION PRIOR TO MEETING WITH YOUR ADVISOR
CougarID: ___________________________________
Name: (Last) _______________________________________ (First) _____________________________
Address: ________________________________________________________ Apt: ________________
City: ______________________________________ State: ________________ Zip: ________________
Telephone Number(s): (Home) ________________ (Cell) ________________ (Work) _______________
Hours per week you study? ___________ work? ___________ commit to other activities? ____________
What caused your academic difficulty? (e.g., medical/personal problems, not ready for college, employment, time
management, death/illness, finances, study/testing skills, career indecision, lack of support, etc.)
1. ___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
List three ways you plan to improve your academic performance. Be specific with your plan.
1. ___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
ADVISOR TO COMPLETE
Semester/ Dismissal:
Semester/ Re-Enrollment:
Total GPA Credits:
Cumulative GPA:
CONDITIONS OF REINSTATEMENT and COURSE RECOMMENDATIONS:
1. Earn a minimum term GPA of 2.0 beginning _______________ Semester, 20___.
2. Meet with Advisor: ________________________________________________________________________
3. _________________________________________________________________________________________
4. _________________________________________________________________________________________
5. _________________________________________________________________________________________
In signing below, I understand that I must make satisfactory progress in accordance with the Standards of Satisfactory Academic Progress
and meet the conditions of reinstatement specified above, including receiving a 2.0 term grade point average (GPA) in order to be eligible for
continued enrollment.
________________________________ ________________________________ Approved Denied
Student Signature Date Advisor Signature Date
________________________________________________
Approved Denied
DIS 02/15 OFFICE COPYWHITE / STUDENT COPYYELLOW
Administrator Signature Date
Standards of Satisfactory
Academic Progress
Total GPA Credits GPA
1 16 1.50
17 32 1.60
33 43 1.75
44 54 1.90
55+ 2.00
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signature
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