Fillable University of West Florida - Appeal for Reinstatement After Removal for Nonpayment

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University of West Florida - Appeal for Reinstatement After Removal for Nonpayment

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APPEAL FOR REINSTATEMENT AFTER
REMOVAL FOR NONPAYMENT
UWF ID Number:
Name:
UWF Email:
Phone Number:
If you are receiving either VA benefits or financial aid (of any kind), a signature from the corresponding office is REQUIRED.
*Indicates a signature is required in order for the request to be considered complete.
Check any/all that apply:
I am NOT receiving any type of financial aid
.
* I am receiving VA benefits and have discussed the actions listed with the Military & Veteran Resource Center.*
*I am receiving financial aid and have addressed the effect of the actions listed with the Office of Financial Aid &
Scholarships.*
Financial Aid Signature:
Date:
VA Benefits Signature:
Date
Reason for Request: Requests are considered only in cases of extenuating circumstances beyond the student's control. Attach appropriate documentation and
additional pages as necessary. (Write on the back of page). I request permission for reinstatement into my courses for the following reasons:
Notes/Instructions to the student:
• This form is used for reinstatements after the first 7 days of initial drop or the 2
nd
reinstatement request.
• If this is your first reinstatement request, please complete the Request For Initial Reinstatement After Removal For Nonpayment form.
• Instructors and Department Chairs MUST approve all Appeal For Reinstatement After Removal For Nonpayment requests.
List the courses below in which you choose to be reinstated:
(*REQUIRED- To be obtained by the student)
CRN #
Subject &
Course No.
Credit
Hrs.
Date
Course
Started
Grade
Mode
*Instructor Signature
Date
Department Chair
Signature
Date
Student Signature:
Date
REGISTRAR OFFICE USE
Term Code:
Completed By:
Date:
Processed: YES NO Notification completed: Controller/Student Accounts Financial Aid Student
Comments:
Updated: 07/01/2019
Phone: 850-474-2244
registrar@uwf.edu
Important Note:
By signing this form you are agreeing to the terms of this appeal. If your appeal is approved:
• You will be charged a $200 reinstatement fee (includes the $100 Late Payment Fee and $100 Late Registration Fee).
• You must be able to make immediate payment.
Reference: UWF REG 4.003, s.1009.24(d) & (e)
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University of West Florida - Appeal for Reinstatement After Removal for Nonpayment

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Completed 23 April 2020

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