Fillable Reinstatement Application for Undergraduate Students (Edinboro University of Pennsylvania)

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Reinstatement Application for Undergraduate Students (Edinboro University of Pennsylvania)

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Created: 12/02/2005 • Revised: 09/19/2019
STUDENT INFORMATION:
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
REINSTATEMENT:
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
Created: 12/02/2005 • Revised: 09/19/2019
CONSENT FOR THE COLLECTION AND PROCESSING OF SENSITIVE OR PERSONAL DATA FOR ADMISSION AND
ENROLLMENT TO EDINBORO UNIVERSITY
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 person’s sex life or sexual
orientation.
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 (pilewski@edinboro.edu). I also understand that the
complete deletion of data will not be feasible in all situations to ensure the University’s 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: _____________________________________________
OFFICE USE ONLY:
______________________________ _________________ _______________________________ __________ _______
DateCurriculum Advisor Date Initials
Mail completed form or use the link below to upload a SAVED copy of the form directly to Dropbox. You do not need to have a Dropbox
account in order to use this link. to: https://www.dropbox.com/request/YG5kQkDnp01MsYVlEe6v.
Office of Records and Registration, Edinboro University, Hamilton Hall, 210 Glasgow Rd, Edinboro, PA 16444.
Reinstatement Application for Undergraduate Students, cont.
Page 2 of 3
Codes for Available
Majors
ASSOCIATE DEGREES
00260 Applied Technology
01261 App. Tech – Electric Utilities 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
BACHELOR OF ARTS DEGREES
00337
Art History
00573 Criminal Justice
English
MustChooseConcentration:
00333 Literature
00334 Writing
00153 Individualized Studies
00309 Journalism
OptionalConcentration:
00310 Digital Media Production
00584 Political Science
00588 Sociology
OptionalConcentration:
00540 Human Service & Community
Development
BACHELOR OF FINE ARTS DEGREES
Applied Media Arts
MustChooseConcentration:
00393 Cinema (Animation, Comp
Animation, Film & Video)
00395 Graphic Interactive Design
00381 Photography
Fine Arts – Studio Arts
MustChooseConcentration:
00382 Ceramics
00383 Drawing
00394 Illustration
00384 Jewelry/Metalsmithing
00386 Painting
00387 Printmaking
00388 Sculpture
00391 Wood/Furniture
BACHELOR OF SCIENCE DEGREES
00525 Accounting
00556 Applied Technical Leadership
OptionalConcentration:
00557 Industrial & Engineering Admin
00397 Art Therapy
00477 Biology
00452 Biology/Pre-Veterinary
Business Administration
MustChooseConcentration:
00490 Comp Business Admin
00422 Finance
00526 Intelligent Enterprise
00492 Marketing
00438 Personal Financial Planning
BACHELOR OF SCIENCE DEGREES, CONT.
00478 Chemistry
OptionalConcentration:
00427 Biochemistry
00443 Forensic Science
00298 Natural Products Chemistry
Computer Science
MustChooseConcentration:
00424 Applied
00415 Cybersecurity
00441 Game & Virtual World Devel
00425 Network & System Admin.
00494 Theoretical
00575 Economics
00418 Environmental Biology
OptionalConcentration:
00419 Wildlife Biology
00308 Exercise Science
00299 Fermentation Science
00470 Geology
OptionalConcentration:
00440 Environmental Geology
Health and Physical Education
MustChooseConcentration:
00267 Teacher Certification
00404 Health Sciences
OptionalConcentration:
00405 Pre-Chiropractic
00406 Pre-Dental
00407 Pre-Medical
00408 Pre-Occupational Therapy
00409 Pre-Optometry
00410 Pre-Physician Assistant
00411 Pre-Physical Therapy
00560 Mathematics
OptionalConcentration:
00558 Actuarial Science
00474 Medical Technology
00610 Psychology
*Must have at least a 2.5 GPA to declare
00674 Social Work
00313 Speech & Hearing Sciences
00307 Sport & Recreation Management
00305 Strategic Communication
BACHELOR OF SCIENCE IN ART EDUCATION
DEGREE
00210 Art Education
OptionalConcentration
00259 Community Arts
BACHELOR OF SCIENCE IN EDUCATION DEGREES
00268 Early Childhood Education
00289 Early Childhood & Deaf Education
00269 Early Childhood (P-4) & Special Ed (P-8)
BACHELOR OF SCIENCE IN ED DEGREES, CONT.
Middle Level Education
MustChooseConcentration:
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
PK-8
Secondary Education
MustChooseConcentration:
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
00518 Social Studies
00519 Social Studies/Special Ed 7-12
NON-DEGREE STUDENTS
00000 Special Student
01118 Quality Assurance Tech Certificate
UNDECLARED (No Program declared)
00104 Undeclared – Arts and Sciences*
*Undeclared students are required to designate a specific
major by the time they have completed thirty semester hours
of work.
Created: 12/02/2005 • Revised: 11/10/2020
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Reinstatement Application for Undergraduate Students (Edinboro University of Pennsylvania)

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Completed 29 January 2021

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