Office of Graduate Studies
Reinstatement Request / Admission Contract
Name:
Student ID#:
Last First MI
Phone Number: ( ) Major:
Graduate Status
Semester on Probation:
Fall
Spring
Classified
Conditionally
Semester Disqualified:
Fall
Spring
Semester Applying:
Fall
Spring
Semester Returning:
Fall
Spring
STEP 1. ATTACH YOUR STATEMENT - Please provide a rationale for re-instatement
Student Signature:
Date:
STEP 2. OBTAIN DEPARTMENT RECOMMENDATIONS CONDITIONS OF ENROLLMENT
# of Visits w/ Advisor:
Max. Units:
Department Name:
Max. Work Hrs:
Repeats:
Do you recommend admission or reinstatement of this student to
your department?
Conditions:
No Yes
If yes, conditions of admission or
reinstatement must be specified Î
Signature of Department Chair Date
STEP 3. SPECIAL PROGRAMS CONDITIONS OF ENROLLMENT
Required only for students served by:
# of Visits w/ Advisor:
Max. Units:
Services to Students with Disabilities, Lassen Hall 1008 Max. Work Hrs:
Repeats:
International Admissions, Lassen Hall Lobby Conditions:
Do you recommend admission or reinstatement of this student to
your department?
No Yes
If yes, conditions of admission or
reinstatement must be specified Î
Signature of Program Counselor / Advisor Date
STEP 4. REINSTATEMENT / ADMISSION DECISION CONDITIONS OF ENROLLMENT
Go to the Office of Graduate Studies, located in the
River Front Center - 206
# of Visits w/ Advisor:
Max. Units:
Max. Work Hrs: Repeats:
Conditions:
Counselor / Advisor Signature Date
DENIED APPROVED
Graduate Dean Signature Date
Distribution: Enrollment Services - White Student - Pink Updated: Oct 200
