Bursar Approval Financial Aid Approval Registrar Approval
Revised 7/27/18
Manor College Reinstatement Form
Students who have graduated or have withdrawn from Manor College and wish to return to an Associate or Bachelor program must complete
the Reinstatement Application to be considered to return to the College. This request is to be completed and sent to the Office of the Registrar
for approvals and processing. By way of this online form, by updating your personal information from what we have on record, you are
authorizing the College to update its official records.
Students who have been academically suspended must first appeal to return.
*Dental Hygiene Students must apply through Admissions. *
Name: Date of Birth:
Maiden Name: Student ID # or SS:
Address: City/State/zip:
Email Address: Contact Number:
Reason for Reinstatement:
Withdrew Reason (Circle one): Medical, Personal, Military Last Year Attended: Program:
Manor Graduate Semester/Year: Degree Program:
If reinstated, when do you plan to enroll? FA SP SU1 SU2 YEAR 20
Have you earned credits from any other College/University since you last attended Manor? (If yes, please
forward all transcripts to the Registrar’s Office for evaluation.) Yes No
Intended Course Load: Full Time (12 or more credits) Part Time (11 credits or less)
Will you need access to Manor College resources? Please Circle. Manor email Student Portal
To be completed by Manor Graduates Only:
Desired Major/Degree Program of study: Associate Bachelor
To be completed by Withdrawn Students Only:
Will you be changing majors? If so, which program? Associate Bachelor
Previous Advisor Signature: New Advisor Signature:
Date: Date:
*Withdrawn students require signature from advisors in order to change major. Failure to do so will delay reinstatement.
Students remain fully responsible for all Manor College fees, any outstanding fines, and repayment of
financial aid as mandated by the Federal Government. By SIGNING YOUR NAME, you confirm that the
information entered into this form is true, you have read the terms and conditions, that you understand them,
and that you agree to be bound by them by way of signature. *
Student Signature: DATE:
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