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If I have not been in attendance, I will be withdrawn from the class(es) and will be responsible for all fees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:
16 week
13 week
7 early
7 late
5 early
5 late
3 week
2 mid
2 late
R and R Use Only
Course #
Section #
Example: 16 week
ENG 111
Comp 1
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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