Fillable The University of Texas at Tyler Undergraduate Student (University of Texas at Tyler)

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The University of Texas at Tyler Undergraduate Student (University of Texas at Tyler)

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NOTE: Once completed, this form is valid for a single semester only. Revised: 02/2020
Notice about Information Laws and Practices
With few exceptions, you are entitled on your request to be informed about the information The University of Texas at Tyler collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled
to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have The University of Texas at Tyler correct information about you that is held by us and that is incorrect, in
accordance with the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that The University of Texas at Tyler collects will be retained and maintained as required by
Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.
The University of Texas at Tyler
Undergraduate Student
Probation Petition for Readmission
Website Version
STEPS TO BE COMPLETED BY STUDENT:
1. Complete section A and attach a copy of your U.T. Tyler transcript to this form.
2. Check the Holds area of your Student Center in myUTTyler and review any/all holds currently on
your account. Some holds may prevent you from being eligible to enroll in courses until resolved.
3. Schedule a meeting with your academic advisor to complete Section B.
4. Return completed petition to the One-Stop Service Center (STE 230). Your record will have an
academic hold which will prevent you from registering online. To register for courses, bring a
completed registration form to the One-Stop Service Center.
Name: _________________________________________ Student ID Number: _______________________
Major: ___________________________ Semester: Fall Spring Summer Year: 20_____
Primary Phone Number: _____________________ Alternate Phone Number: _____________________
Section A: Please summarize how you arrived at this point in your education. Please list how you plan to
change your academic status. Complete a Change of Program Form if planning to change programs.
Student’s Signature: ______________________________________________ Date: ____________
International Counselor: ___________________________________________ Date: ____________
(Required for all International students)
Office Use Only
Semester/Year:
__________________
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NOTE: Once completed, this form is valid for a single semester only. Revised: 02/2020
Notice about Information Laws and Practices
With few exceptions, you are entitled on your request to be informed about the information The University of Texas at Tyler collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled
to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have The University of Texas at Tyler correct information about you that is held by us and that is incorrect, in
accordance with the procedures set forth in The University of Texas System Business Procedures Memorandum 32. The information that The University of Texas at Tyler collects will be retained and maintained as required by
Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.
Section B
Academic Advisor: ____________________________________ Appointment Date: ______________
Recommendations: (May include support services, counseling, advisor meetings, or enrollment restrictions.)
Readmit Readmit with Restrictions Do not readmit
Advisor / Department Chair Signature: __________________________________________________
For Which Semester/Year: _____________________________________ Date: ____________
One (1) semester only
Return completed petition and Registration Form to One-Stop Service Center (STE 230).
OFFICE USE ONLY
Holds: No holds Hold(s) still pending as-of date: ____________ (Return form to student)
Completed by: _________________________________ Date: ___________________
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The University of Texas at Tyler Undergraduate Student (University of Texas at Tyler)

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Completed 24 July 2020

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