Petition for Academic Reinstatement • College of Human Sciences • Iowa State University

Part A

Name:

First Last

ISU ID #

Date:

Current address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email:

Phone:

Term of requested reinstatement (semester/year):

Proposed major:

Academic adviser in proposed major:

How many times have you been dismissed from ISU:

Term of last dismissal:

What college were you dismissed from:

Part B

Please complete the following information regarding credits you have earned since leaving Iowa State University. List below coursework and grades you have completed:

Name of College/University	Course Name	# of Credits	Term	Grade

List below courses in which you are currently enrolled and expected grades.

Name of College/University	Course Name	Expected Grade

Please attach a current grade report. This could be an email from your professor or a screenshot from your computer or phone of your completed and/or in-progress grades. NOTE: You will also need to submit an official transcript of all coursework completed outside of Iowa State University.

Current Grade Report

Part C

In this section, we would like to see evidence that you recognize what it will take to complete your program, and whether or not this program fits your abilities and goals. Answer all questions as completely as possible. You may add other documents that support your position.

Describe how your selected major fits your career goals.

If you did not take 9 credits at another college or university, or seek exemption from coursework during your dismissal period, elaborate on the reasons why.

Discuss your readiness to be successful at ISU by responding to the following 4 questions

What were the academic issues that influenced your performance at ISU? (e.g., lack of study skills, commitment to academics, etc.)

What were your personal issues that influenced your performance at ISU? (e.g., personal trauma/illness, etc.)

In response to the above information, what actions have you taken to address these issues so that you are ready to return?

What support strategies and resources will you use to promote your academic success should you be reinstated?

Part D

Complete the following:

Number of credits remaining to complete your program:

Number of credits you plan to take each semester:

Will you attend summer semester?

Yes
No

Do you plan to work while in school?

Yes
No

How many hours/week?

What is your expected GPA in courses remaining?

Do you plan to repeat any courses?

Yes
No

Which ones?

Expected date of graduation: