Office of Records and Registration
640 Bay Road, Queensbury, NY 12804-1445
CALL: 518.743.2279 | FAX: 518.832.7601 | EMAIL: registrar@sunyacc.edu
Request for Re-Admission after Academic Dismissal
Students who have been dismissed from the college are not allowed to return to SUNY Adirondack for one calendar year.
After a one-year absence students can file a request for Re-Admission.
If granted approval to re-enroll, the student will be placed on Academic Probation and may not register for more than 14 credit
hours.
A completed form must be accompanied with a signed registration form.
Completed forms should be submitted to the Registrar’s Office for Processing.
Student Name (Please print): ___________________________________ Banner ID: _____________________
Semester seeking to re-enroll: ❑ Summer ❑ Fall ❑ Winter ❑ Spring Year: _______
Semester of Dismissal: ❑ Fall ❑ Spring Year: _______
Major: ____________________________________________
Street Address: __________________________________________________________________________________________
City, State, Zip Code: _____________________________________________________________________________________
Statement: Please write a brief statement of your activities since your dismissal.
Student Success Staff Only:
Re-Admission Appointment Date: _________________________________
Student Success/Wilton Staff Signature: _______________________________________ Date: _____________________
For Registrar’s Office Use ONLY:
Moved to Probationary Status: Yes No Initials: _______________ Date Processed: _________________
Form Updated: 10/29/2019
