Bursar Approval Financial Aid Approval Registrar Approval
__________________________ __________________________ __________________________
Revised 9/15/2020
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Students who have graduated or have withdrawn from Manor College and wish to return to an Associate or Bachelor program must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. *
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 fewer)
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To be completed by Withdrawn Students Only: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*Withdrawn students require signature from advisors in order to change major.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.
Signature
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: ___________________________
Name: ___________________________________ Date of Birth: ___________________________
Maiden Name: ____________________________ Student ID # or SS: _______________________
Address: _________________________________ City/State/zip: ___________________________
Email Address: ____________________________ Contact Number: _________________________
