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University of West Florida - Request for Initial Reinstatement After First Remove for Nonpayment

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REQUEST FOR INITIAL REINSTATEMENT
AFTER FIRST 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 discussed 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 back of page). I request permission for reinstatement into my courses for the following reasons:
Semester:
Fall
Spring
Summer
Year:
List the courses below in which you choose to be reinstated:
CRN #
Subject & Course No.
Credit Hrs.
Date Course
Started
Grade Mode
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:
Only accepted within 7 calendar days after courses have been dropped due to non-payment.
By signing this form you are agreeing to the terms of the reinstatement. If your request 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 pay within 7 calendar days.
• Only accepted within 7 days after courses have been dropped due to non-payment.
• If after the first 7 days of initial drop or the 2
nd
reinstatement request the Appeal For Reinstatement After Removal For Nonpayment
form should be used.
Reference: UWF REG 4.003, s.1009.24 (d) & (e)
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University of West Florida - Request for Initial Reinstatement After First Remove for Nonpayment

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Completed 23 April 2020

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