Reinstatement Appeal Form

Office of Records

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University of Texas at Arlington
Office of Records
Box 19088
Arlington, TX 76019-0088

. Phone: 817-272-3372
. Fax: 817-272-3223
. Email: records@uta.edu

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Reinstatement Appeal

Reinstatement Appeals are intended for students who have been dropped for non-payment or other reasons after Census day.

DO NOT USE THIS FORM IF:

If you have been dropped for non-payment for the term prior to Census Day. Re-register for your classes and make payment the same day to avoid being dropped again.
If you are on Academic Dismissal and would like to return to the University prior to the end of your period of dismissal. Contact your Academic Advisor within your major department.
If you are a returning student who has not attended in over a year and would like to return. Visit the Admissions website at www.uta.edu/admissions and click on the Former Student link.

Student ID#:

Student's full name:

Current Street Address:

City:

State:

Zip Code:

Email:
Daytime Phone #:
Semester/Year for which refund is requested:
Classification: Freshman Sophomore Junior Senior Degreed Undergraduate Graduate (Masters/PhD)
In the space below, write why you are requesting that an exception be granted to the university's reinstatement policy. Documentation that supports the claim must be submitted before a decision will be made. In the case of illness, for example, a letter would be needed from the physician explaining why withdrawal from classes is necessary. The Registrar's office is not authorized to reinstate a student after semester grades are submitted.
Please check this box if you have supporting documents: Submit supporting documentation to: UTA Registrar's Office Attn: Tuition and Fee Appeals Box 19088 Arlington, TX 76019 or Fax to: 817-272-3223 Within 21 days after the appeal form and related documents are received, the Tuition and Fee Refund Appeal Committee will issue a decision on the appeal.

*You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas Government Code. For more information, see our Privacy Policy.