Created: 12/02/2005 • Revised: 09/19/2019
Last 4 Digits of Edinboro University Student ID: @ X X X X ___ ___ ___ ___ Date of Birth: ______________________
Name: Last _____________________________________ First _____________________________________ M.I. _______
Former Name(s)_________________________________________________________
Home Phone: ____________________ Cell Phone: ____________________ OK to Text: Yes No
Personal email: _____________________________________
Home Address: _______________________________________________________________________________________
Street City State Zip Code
Are you a legal resident of PA? Yes No Are you a US Military Veteran? Yes No
Are you an International Student? Yes No
Term: (Check One): Fall 20___ Wintersession 20___ Spring 20___ Summer 20____
Would like to Return: Full Time Part Time
I am requesting reinstatement with the following major (See major codes on page 3):
Code: ______ Major: ____________________________________________________________
Special Students (Non-degree seeking) are permitted to remain in attendance for no longer than the equivalent of one
academic year or 30 semester hours of credit.
List below the institutions, if any, you have attended since you last attended Edinboro University. If you attended any
other institution(s) while away from Edinboro University, please request the institution to send an ocial transcript
of your course work directly to the Admissions Oce, Edinboro University of Pennsylvania, 200 East Normal Street,
Edinboro, PA 16444. Transcripts given to students or marked issued to student” are not ocial and will not be accepted.
Note: Failure to list all previously attended institutions could result in disciplinary action. Transfer students will be
required to have a student standards data form completed by the previous school(s).
Institution(s) Attended
(Submit additional page if needed) Date of Attendance
___________________________________________________ ______________________________
___________________________________________________ ______________________________
Have you ever been convicted of a felony? Yes No
If YES, please state the felony oense, date of conviction and provide relevant information concerning the felony
conviction. __________________________________________________________________________________________
I certify that the above statements are correct and understand that any misrepresentations by me on this application form
could lead to future disciplinary action by the University. My signature attests to the fact that I have read and understand the
conditions of reinstatement.
Student Signature: ___________________________________________________________ Date: ___________________
Form must also be signed on back to be processed.
Page 1 of 3
Reinstatement Application for Undergraduate Students
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Created: 12/02/2005 • Revised: 09/19/2019
Pursuant to the European Union General Data Protection Regulation (EU GDPR), the Pennsylvania State System of
Higher Education and its member universities, including Edinboro University of Pennsylvania (“University”), in its
capacity as a data controller under the EU GDPR, must obtain explicit, armative consent before it can collect or
process any sensitive or personal data for a lawful basis including for admission and enrollment purposes.
1. Sensitive data includes data revealing racial or ethnic origin; political opinions; religious or philosophical beliefs;
trade union membership; genetic or biometric data; health data; or data concerning a persons sex life or sexual
2. Any sensitive or personal data that is collected will be for the sole purpose of application for admission to the
University that is sent from the EU and is necessary for that purpose or for any purpose permitting the use of
sensitive or personal data under applicable law or to meet other compliance obligations of the University.
3. I understand that any sensitive or personal data that is collected will also be used to report serious illness, injury,
or other health or emergency situations involving me, as well as to address or report discrimination, harassment,
sexual or gender-based misconduct and criminal behavior which may be committed by or against me or
otherwise involve me, on or o campus, to appropriate authorities including sta, faculty, and administrators of
the University or appropriate legal or governmental authorities under applicable policies of the Pennsylvania
State System of Higher Education or the University (including but not limited to applicable codes of conduct)
and applicable laws (including but not limited to Title IX and the Clery Act).
4. I understand that refusal to consent to the use of sensitive or personal data, and the transfer of sensitive or
personal data overseas, for the purpose outlined in this notice may make it impossible for the University to carry
out necessary activities, and may preclude the University’s ability to provide requested services.
5. I understand I have the right to withdraw consent to the collection and processing of sensitive or personal data
and to do so, I must contact Mr. Tim Pilewski, Registrar ( I also understand that the
complete deletion of data will not be feasible in all situations to ensure the Universitys ability to comply with
regulatory requirements.
My signature attests to the fact that I have read and understand the conditions listed above.
Student Signature: ________________________________________ Date: ___________________
PRINT NAME: _____________________________________________
______________________________ _________________ _______________________________ __________ _______
Curriculum Date Advisor Date Initials
Mail or Fax Completed Form to: Oce of Records and Registration, Edinboro University
Hamilton Hall, 210 Glasgow Rd, Edinboro, PA 16444, Fax: 814.732.2130, Phone: 814.732.3501
Reinstatement Application for Undergraduate Students, cont.
Page 2 of 3
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Codes for Available Majors
00260 Applied Technology
00262 Applied Tech - Aeronautical Science
00502 Business Administration
00401 Computer Science
00501 Criminal Justice
00503 Human Services – Social Services
00207 Liberal Studies
00244 Manufacturing Engineering Technology
00402 Pre-Pharmacy
00403 Pre-Pharmacy – LECOM
00242 Pre-School Education
Porreco Programs
01261 Applied Tech - Electric Utilities Technology
01502 Business Administration
01503 Human Services – Social Services
01207 Liberal Studies
00570 Anthropology
Optional Concentration:
00565 Forensic Anthropology
00337 Art History
00573 Criminal Justice
Must Choose Concentration:
00333 Literature
00334 Writing
00566 Environmental Studies
00582 History
00153 Individualized Studies
00309 Journalism
Optional Concentration:
00310 Digital Media Production
00584 Political Science
00588 Sociology
Optional Concentration:
00540 Human Service & Community
Applied Media Arts
Must Choose Concentration:
00393 Cinema (Animation, Comp
Animation, Film & Video)
00395 Graphic Interactive Design
00381 Photography
Fine Arts – Studio Arts
Must Choose Concentration:
00382 Ceramics
00383 Drawing
00394 Illustration
00384 Jewelry/Metalsmithing
00386 Painting
00387 Printmaking
00388 Sculpture
00391 Wood/Furniture
00525 Accounting
00556 Applied Technical Leadership
Optional Concentration:
00557 Industrial & Engineering Admin
00477 Biology
00452 Biology/Pre-Veterinary
Business Administration
Must Choose Concentration:
00490 Comp Business Admin
00422 Finance
00438 Personal Financial Planning
00423 International Business
00492 Marketing
00478 Chemistry
Optional Concentration:
00427 Biochemistry
00443 Forensic Science
Computer Science
Must Choose Concentration:
00424 Applied
00441 Game & Virtual World Devel.
00425 Network & System Admin.
00494 Theoretical
00437 Web & Mobile Application
00562 Data Analytics
00575 Economics
00418 Environmental Biology
Optional Concentration:
00419 Wildlife Biology
00308 Exercise Science
00299 Fermentation Science
00470 Geology
Optional Concentration:
00440 Environmental Geology
00533 Geographic Information Science
Health and Physical Education
Must Choose Concentration:
00267 Teacher Certi cation
00404 Health Sciences
Optional Concentration:
00405 Pre-Chiropractic
00406 Pre-Dental
00407 Pre-Medical
00408 Pre-Occupational Therapy
00409 Pre-Optometry
00410 Pre-Physician Assistant
00411 Pre-Physical Therapy
00306 Health & Wellness Studies
00560 Mathematics
Optional Concentration:
00558 Actuarial Science
00474 Medical Technology
00433 Physics
Optional Concentration:
00416 Materials Science
00417 Cooperative Engineering Physics
00610 Psychology*
*Must have at least 2.5 GPA to declare
00674 Social Work
00313 Speech and Hearing Sciences
00307 Sport & Recreation Management
00305 Strategic Communication
00210 Art Education
Optional Concentration
00259 Community Arts
00268 Early Childhood Education
00289 Early Childhood & Deaf Education
00269 Early Childhood (P-4) & Special Ed (P-8)
Middle Level Education
Must Choose Concentration:
00271 English / Lang Arts / Reading
00280 English/Lang Arts/Reading/
Special Education PK-8
00272 Mathematics
00275 Math/English/Lang Arts/Reading
00276 Math & Science
00277 Math & Social Studies
00281 Math and Special Education PK-8
00282 Math/English/Lang Arts/Read/
Special Education PK-8
00283 Math/Science/Special Edu PK-8
00284 Math/Social Studies/Special
Education PK-8
00273 Science
00278 Science/Engl/Lang Arts/Reading
00285 Science/English/Lang Arts/ Read/
Special Education PK-8
00279 Science & Social Studies
00286 Science/Special Education PK-8
00287 Science/Social Studies/
Special Education PK-8
00274 Social Studies
00288 Social Studies/Special Education
Secondary Education
Must Choose Concentration:
00506 Biology
00507 Biology/Special Ed 7-12
00508 Chemistry
00509 Chemistry/Special Ed 7-12
00510 Comprehensive English
00511 Comprehensive English/Special Ed 7-12
00514 Mathematics
00515 Mathematics/Special Ed 7-12
00516 Physics
00517 Physics/Special Ed 7-12
00518 Social Studies
00519 Social Studies/Special Ed 7-12
00000 Special Student
01118 Quality Assurance Tech Certi cate
UNDECLARED (No Program declared)
00104 Undeclared – Arts and Sciences*
*Undeclared students are required to designate a speci c
major by the time they have completed thirty semester hours
of work.
Created: 12/02/2005 • Revised: 08/27/2019
Page3 of 3