Petition for Reinstatement to Graduate Study
Directions for completing this Petition:
1. Meet w
ith your Program Coordinator.
2. Complete the information on this form.
3. Using the space at the bottom of the page and a separate page if necessary to supply the following information
a. Provide an explanation for the performance that led to your dismissal.
b. Outline what steps you have or will take to overcome the difficulties that led to your dismissal.
c. Explain any factors that you feel will lead to improved performance in the future.
4. Take this form and the attached letter to the individuals listed on the second page in the order in
which they are listed so that they may comment on your request for reinstatement and indicate
their approval or disapproval.
Surname/Family/Last Given/First Middle Maiden/Other
Date:_____/_____/____ BU ID#_____________________
day / month / year
Current Address:________________________________________________________________________________________
City:_________________________________ State:_____________ Zip:_______________________
Home Phone:__________________ Work Phone:_________________ Email:______________________________________
In the space below and additional pages as necessary please enter your response to the questions indicated in section 3
The Dean of the Graduate School will distribute copies of the completed form along with the final recommendation to the
Program Coordinator/Director, Department Chair, College Dean and the Registrar.
1501 W. Bradley Ave., Peoria, IL 61625
(309) 677-2375
To Be Completed by the Graduate Dean
Graduate Dean’s signature ______________________________ Date __/__/__ Approve Disapprove
To Be Completed by the College Dean
College Dean’s signature ________________________________________ Date __/__/____ Approve Disapprove
To Be Completed by the Department Chair/Division Director
Chair/Directors signature _______________________________________ Date __/__/__ Approve Disapprove
To Be Completed by the Graduate Coordinator:
Please comment on any circumstances which may have affected this student’s academic performance. Please
provide your recommendations for this student and recommend conditions for continuation. If you have additional
comments you may write them below, or send a letter to the Dean of the Graduate School.
Coordinator's signature ___________________________________ Date_____/____/___ Approve Disapprove