FORM

Reinstatement
Use this form to request reinstatement after being dismissed from a course or program.

A meeting with the CSSO or CAO is required as part of the reinstatement application. You will be contacted to set up an appointment.

Questions: Contact your advisor or Registrar@uwest.edu

Questions regarding F-1 status and requirements: ISS@uwest.edu
DATE SUBMITTED*

MonthDayYear
Date
NAME*

First NameFamily / Last Name
STUDENT ID*
PHONE*
EMAIL*
example@example.com
CURRENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
INTERNATIONAL STUDENT (F-1)*

NOYES
LEVEL OF STUDY*

UndergraduateGraduateIntensive EnglishNon-Degree
PROGRAM*

Business AdministrationLiberal ArtsPsychologyUndeclared
PROGRAM*

DBMIN Buddhist MinistryMA Buddhist Spiritual CareMA PsychologyMA Religious StudiesMBA / Professional MBA / Post MBAMDIV Buddhist ChaplaincyPHD Religious Studies
ENROLLMENT*

Undergraduate CertificateGraduate CertificateOpen Enrollment
CONCENTRATION*

AccountingComputer Information SystemsInternational BusinessMarketingNot Yet Declared
AREA OF STUDY*

Marriage & Family TherapyMulticultural Counseling (non-licensure)
CONCENTRATION*

NONEComputer Information SystemsData AnalyticsFinanceInternational BusinessNonprofit Organization ManagementDual Concentration
CONCENTRATION *
CONCENTRATION 2*
CONCENTRATION*

NONEBuddhist TextsComparative ReligionHumanistic BuddhismMindfulness, Meditation, & Mind
PhD concentrations applicable only to students who began studies prior to Fall 2022.
CONCENTRATION*

NONEBuddhist StudiesComparative Religious Studies
TERM*
E.g. Fall 2023
TYPE OF REINSTATEMENT*

Course(s), Immediate ReinstatementProgram, Immediate ReinstatementProgram, After Break in Enrollment
LIST COURSES FOR REINSTATEMENT CONSIDERATION

Do not include courses you were not dismissed from (still on roster), or those you were dismissed from and do not plan to complete this term.
COURSE*
Include course code and title
ANOTHER COURSE?*

NOYES
COURSE*
Include course code and title
ANOTHER COURSE?*

NOYES
COURSE*
Include course code and title
ANOTHER COURSE?*

NOYES
COURSE*
Include course code and title
Your advisor will assist you with reentry and registration after your reinstatement is approved.
- Break in enrollment less than two full terms (spring and fall):
- Break in enrollment two full terms or more:
LAST TERM ATTENDED*
E.g. Fall 2021
REASON FOR DISMISSAL*

AcademicAttendanceConductIntegrity
EXPLAIN CIRCUMSTANCES THAT LED TO DISMISSAL*
Please be specific
EXPLAIN WHY YOU SHOULD BE REINSTATED*
If documentation is available, be prepared to email it to the CAO/CSSO upon request
DESCRIBE STRATEGIES YOU PLAN TO UTILIZE TO SUCCEED IF REINSTATED*
Please include strategies specific to you, rather than generalizations.
By signing, I verify that I am the student of record. If approved, I agree to fulfill any terms of reinstatement to the best of my ability.
Signature*

Clear
REGISTRAR'S OFFICE

Date Processed: Processed By:

Comments:
Should be Empty:

Reinstatement