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Must be completed as per the attached Petition Deadlines for the semester you wish to attend. Reinstatement Petition Form Petition Due on or before // Name Last First Washburn ID Number W Today s date // MI MM/ DD/ YYYY Maiden name if applicable Current U.S. Mailing Address Street Apt. City State Zip Code Daytime Phone Email address For what semester are you requesting reinstatement Circle one. Fall / Spring / Summer Year Have you had a previous reinstatement Y/N If yes what semester Fall / Spring / Summer Have you completed an Application for Admission at the Admissions Office Morgan 114 or at www. washburn*edu Y / N How many hours do you anticipate taking Have you met with an Academic Advisor Y / N If so whom Will you apply for Financial Aid Y / N Please list any academic institutions attended since you were last enrolled at Washburn Institution Semesters/ Years Attended Please submit this form with your typewritten narrative to the Academic Affairs Office at Bradbury Thompson Alumni Center Suite 200 or mail to VPAA Washburn University 1700 SW College Ave Topeka KS 66621. City State Zip Code Daytime Phone Email address For what semester are you requesting reinstatement Circle one. Fall / Spring / Summer Year Have you had a previous reinstatement Y/N If yes what semester Fall / Spring / Summer Have you completed an Application for Admission at the Admissions Office Morgan 114 or at www. Fall / Spring / Summer Year Have you had a previous reinstatement Y/N If yes what semester Fall / Spring / Summer Have you completed an Application for Admission at the Admissions Office Morgan 114 or at www. washburn*edu Y / N How many hours do you anticipate taking Have you met with an Academic Advisor Y / N If so whom Will you apply for Financial Aid Y / N Please list any academic institutions attended since you were last enrolled at Washburn Institution Semesters/ Years Attended Please submit this form with your typewritten narrative to the Academic Affairs Office at Bradbury Thompson Alumni Center Suite 200 or mail to VPAA Washburn University 1700 SW College Ave Topeka KS 66621. City State Zip Code Daytime Phone Email address For what semester are you requesting reinstatement Circle one. Fall / Spring / Summer Year Have you had a previous reinstatement Y/N If yes what semester Fall / Spring / Summer Have you completed an Application for Admission at the Admissions Office Morgan 114 or at www. washburn*edu Y / N How many hours do you anticipate taking Have you met with an Academic Advisor Y / N If so whom Will you apply for Financial Aid Y / N Please list any academic institutions attended since you were last enrolled at Washburn Institution Semesters/ Years Attended Please submit this form with your typewritten narrative to the Academic Affairs Office at Bradbury Thompson Alumni Center Suite 200 or mail to VPAA Washburn University 1700 SW College Ave Topeka KS 66621. .

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