RGR-466-022 0
UNDERGRADUATE REQUEST FOR ACADEMIC REINSTATEMENT
Date ________________________________________
Student Name ____________________________________________________ Student ID No. __________________________ Current Major Code _____________
Last First
Semester to be o Fall ________________________________ o Spring _________________________ o Summer _________________________
reinstated: Academic Year Academic Year Academic Year
Do you plan to change your major? o Yes* New major name _____________________________________________________________ o No
*Must contact new department
Describe any obstacles that may have contributed to your dismissal and the actions you have taken to reduce them
Describe your plans to improve your academic performance
Email form to student-records@t.edu. Be prepared to schedule an appointment with either your academic advisor and/or department head
after you receive the results of the appeal. Any Financial Aid correspondence will be sent to you separately.
Your appeal will be evaluated by the Academic Standing Committee.
TIME SENSITIVE! Refer to the Registrar’s communication to you for due date
___________________________________________________________________________________________________________________________________________
Student Signature Date
Additional space on reverse
Florida Institute of Technology § Oce of the Registrar § 150 West University Boulevard, Melbourne, FL 32901-6975 § 321-674-8115 § Fax 321-674-7827 § student-records@t.edu
