White: Records and Registration Bursar: Yellow Student:Pink
Reinstate Form
I understand that:
If I have not been in attendance, I will be withdrawn from the class(es) and will be responsible for all fees
I have to be reinstated in all of the same classes/sections that I was dropped unpaid from
I have to be prepared to pay today for all courses including all fees associated with being reinstated
(please see catalog details)
Steps to Take:
complete Reinstate Form
get appropriate approving signature from the Division of Student Development and Enrollment
Management – Vice President, Dean, Registrar, Associate Registrar or Assistant Registrar)
bring signed form and pay at the Bursar’s office
bring back to Records and Registration for processing
Please Print:
Last Name _______________________________________First Name________________________________
CCM ID _____________________ I receive Financial Aid Yes No
Please indicate (below) the appropriate semester/mini term for the course you are reinstated:
Semester : (check one) Fall Spring Summer Winter YEAR _________
Indicate Mini Term for each course in the Term column below:
I understand that this reinstatement will incur tuition costs and all fees associated with reinstatement. I agree
that I will be responsible to pay today.
Student Signature _______________________________________________________________ Date__________
Student Dev. and Enrollment Mgt. Signature __________________________________________Date _________
REG 8/2018
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signature
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