Revised Feb. 2018
Guidelines for Reinstatement
FINANCIAL AID MAY NOT BE AVAILABLE FOR REINSTATED STUDENTS
Please see a Financial Aid Advisor to discuss a possible Standards of Academic Progress (SAP) Appeal.
Academic Dismissal Policy - Academic dismissal is an involuntary separation imposed upon a student who,
having been previously suspended from the College and readmitted, fails to regain good academic status or
achieve a minimum 2.0 term grade point average (GPA) for each academic term. Academic dismissal requires
the student to stay out of school for one full calendar year to reflect on his/her commitment to education and
to make any necessary changes to facilitate future success. Academic dismissal is noted on the student’s
permanent record. Students readmitted after being academically dismissed will be on an academic probation
and must meet with an academic advisor prior to registering for classes.
Note: Students on academic suspension or dismissal are eligible to enroll in PSAV or avocational courses.
PLEASE READ BEFORE FILLING OUT THIS REQUEST FORM.
FINANCIAL AID - This request is to reinstate you academically in the College but does not signify that you
are eligible for Financial Aid. Please speak with a Financial Aid advisor regarding ways to finance your
education, including a possible SAP appeal.
INTERNATIONAL STUDENTS All International Students must meet with the International Admission and
Recruitment Manager before submitting a request. Do not submit this form without the Manager’s
approval.
TRANSCRIPTS - If you have attended another educational institution while on dismissal, you must request
that an official copy be sent to Palm Beach State College before you meet with your advisor. Please bring
an unofficial copy to your appointment with your advisor.
Steps for filing a Request for Reinstatement
1. R
equest that official transcripts from other educational institutions be sent to Palm Beach State College
(PBSC), if applicable.
2. Complete the Request for Reinstatement form.
3. Sign and date the form.
4. Make an appointment to meet with the designated Advisor to develop or update your educational plan and
review this request.
Request For Reinstatement Form After Academic Dismissal
2 | Page
Only COMPLETED forms will be accepted for review.
Before meeting with your advisor, fill out this form; then, make the appointment.
Requests will not be accepted without this form and required transcripts, if applicable.
Part I Student Information
PRINT Name: ___________________________ _________________ ____ Student ID #:________________
LAST FIRST MI
Local Address: _____________________________________________ ______________________ ____ ________
City State Zip Code
Home Telephone #: (_____) ________________ Cell: (_____) _______________ Work: (_____) ________________
Student College Email address: _________________________________________________@my.palmbeachstate.edu
Part II Course Information
A. Explain why you were unsuccessful in your classes.
Request For Reinstatement Form After Academic Dismissal
3 | Page
Only COMPLETED forms will be accepted for review.
B. Explain what you have done during the past year to improve the issues/reasons you were unsuccessful in your classes. If
you have attended another educational institution, have you requested that your transcript be sent to PBSC?
C. Explain what you plan to do in the future to assure success with your classes.
Part IIIRespond to these time obligations. How many hours on average do you spend each week on the following?
ACTIVITY Number of Hours
Homework
In class
Working a job
Traveling to/from work
Traveling to/from school
With childcare/family obligations
Internet/social media
Sleeping
Preparing and/or eating meals
On personal hygiene
(showering, grooming,
etc.)
Participating in religious activities
On chores (laundry, shopping, etc.,)
Socializing/attending leisure activities
Watching TV
Total Hours:
REFLECTION:
There are a total of 168 hours in one week. How does your total
hours compare to 168 hours per week? If you run out of hours
in one week, what can you do to reduce or eliminate some
activities to allow you additional hours toward your
coursework?
Please Comment:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Request For Reinstatement Form After Academic Dismissal
4 | Page
Only COMPLETED forms will be accepted for review.
Par
t IV Respond to the following questions.
1. How will you plan and organize your time?
2. If you are working, how has your work schedule changed to allow you more time to focus on your courses?
3. What is different about your obligations at home since you were dismissed?
4. What academic support systems will you use to help you pass your courses? Student Learning Center (SLC) is
free for all students.
Request For Reinstatement Form After Academic Dismissal
5 | Page
Only COMPLETED forms will be accepted for review.
Par
t VPlease add any additional comments below.
S
tudent Signature __________________________________________ Date: _________________________
FOR OFFICIAL USE ONLY
ADVISOR:
I recommend reinstatement for Term/Year: ____________ Campus: _______________________
Limited to: ______________________________________________________________________________________
Advisor Signature: __________________________________
Print Name: ___________________________________________
REGISTRAR
Processed Reinstatement Approval Dated: _____________________ Initial:____________
Campus Location: ___Belle Glade ___Boca Raton ___Lake Worth ___Loxahatchee Groves ___Palm Beach Gardens
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