Petition for Reinstatement form

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Petition for Reinstatement
Saint Louis University
University College
221 North Grand Blvd. St. Louis, MO, 63103
Phone: 314-977-2369 Fax: 314-977-1424
Name:_________________________________________________ ID#:000________________ Cell#:________________________
(Please print clearly)
Last
First
Address for Reply: ________________________________________________________________ Email:[email protected]
Street
City
State/Zip
1) Semester dismissed:
Semester__________
Year______
2) Seeking reinstatement for:
Semester__________
Year______
3) Complete the GPA calculator and estimate grades for the semester you are seeking reinstatement. Record the minimum
semester GPA you must earn in order to attain a cumulative GPA of 2.0 or higher: _______________. If you are not able to attain a
cumulative GPA of 2.0 within one semester, indicate which semester you will attain a 2.0 cumulative GPA: ______________.
4) Attach the following documents to your petition:
A. Completed Self-Assessment
B. Provide a written statement that addresses factors that contributed to your dismissal from Saint Louis University. This
statement should also outline the plan you will follow to improve your academic standing if reinstated.
C. Your response should also address your class attendance, study habits/ skills, time management, interactions with
instructors/ advisors, and utilization of campus resources. You may also address decisions regarding your intended major.
D. Lastly, if applicable, provide supporting documentation (e.g. medical statement/record).
STATEMENT OF COMPLIANCE WITH UNIVERSITY COLLEGE PETITION FOR REINSTATEMENT POLICIES AND PROCEDURES
Please read and sign petition
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I understand that this Petition for Reinstatement, as well as the supporting documentation, must be received at the University College
Office (Student Success Center, BSC 331) no later than Friday, July 13, 2012.
I understand that it is my responsibility to contact University College (Major Exploration Advising) regarding the status of my Petition for
Reinstatement if I have not received email confirmation of my status on Friday, July 20, 2012.
I understand that reinstatement is not automatic or guaranteed.
I understand that if reinstated, failure to attend Saint Louis University during the designated semester of reinstatement will negate this
agreement and that I will be required to apply for readmission for any subsequent semester.
I understand that reinstatement requires specific conditions stated in the probation contract, which will be discussed and completed with
the Program Director of Major Exploration Advising.
If reinstated, I must meet with the Program Director of Major Exploration no later than Friday, September 7, 2012.
Signature: ___________________________________________________
Date: ____________________________________
FOR OFFICE USE ONLY
Def. Pts.______ # Sem _______
Program Director Reinstatement Recommendation:
Approve: _____
Deny: _____
Comments/Conditions: _________________________________________________________________________________________________
Signature: ____________________________________________________
Date: _________________________________________
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