OFFICE OF THE REGISTRAR
MSC 105, 1050 W. SANTA GERTRUDIS AVE
KINGSVILLE, TEXAS 78363-8202
PH (361) 593-2811 * FAX (361) 593-2195
REQUEST FOR REINSTATEMENT
There will be a $100 fee charged for reinstatement of one or more classes.
Student’s Name: _______________________________________ SSN/Student ID: _____________________
College: ______________________________________________ Major: ____________________________
Classification: FR SO JR SR GR
Semester: _____________________________ Year: ______________
Permission is requested to allow the named student to be reinstated for the indicated semester. It is understood
that by allowing the student to be reinstated that the student will pay for his/her tuition and fees immediately
after the reinstatement has been processed.
Reason for request: ________________________________________________________________________
Registrar Use Only:
Processed By Date
Acknowledgement: I understand that immediately after being reinstated I am required to pay for my tuition and fees in full. Failure
to do so will result in being dropped again without the possibility of further reinstatement in the current semester.
Student’s Signature Date