Please Answer the Following Questions, and Submit This Form To

Request for Readmission following separation

Student Name: / Student ID Number:

Please answer the following questions, and submit this form to

1. Semester you wish to return: / Year:
2. Please list the major you would like to be continued/readmitted to:
If you are not granted readmission in your major of choice, your application can be considered by a second major department or program. There is no guarantee of readmission based on choice of major, department or program. For a complete listing of majors view the degree programs outlined in the Clarkson catalog: http://www.clarkson.edu/catalog/
Please indicate a second choice major (if applicable):
3. If you are requesting readmission/continuance to a major different from what you were last enrolled in at Clarkson, please explain why you are choosing this major:
4. Please describe the circumstances that led to your academic separation and your plans to address these issues (200 word limit).
5. If there were extenuating circumstances (beyond your control) that contributed to your separation from the University, please explain below. What is your plan to address, or manage these circumstances?
6. Are there any health factors/issues (physical, mental, and/or emotional) that contributed to your separation? Please explain. If yes, what is your plan to address, or manage this condition?
7. What courses do you plan to take over the next year (including summer sessions) to re-establish academic Good Standing? See Clarkson’s Rules and Regulations III-R Academic Standing: http://www.clarkson.edu/studentaffairs/regulations/iii.html
8. What campus resources (if any) did you utilize during the past semester?
9. If you are continued/readmitted, what campus resources (if any) will you be utilizing (example: Student Success Center)? Please be specific in how you intend to use these resources. If you are continued, what off-campus resources (if any) will you be utilizing? Please be specific in how you intend to use these resources.
10. Did you take any classes at another university while you were away that you plan to transfer back to Clarkson? If so, please list those classes below. Credit will be awarded for approved courses upon receipt of an official transcript indicating a grade equivalent to the “C” grade or higher at Clarkson and pending course approval from your academic department.
11. If there is any other pertinent information you wish to include, please do so below:

Information regarding financial aid:

If you are a financial aid recipient, keep in mind that Satisfactory Academic Progress standards for federal and university financial aid are different from academic standing. As a separated student, your petition for continuance must be approved before your financial aid eligibility will be reviewed and your financial aid status can be determined. Please refer to the following chart, based upon federal government guidelines, Clarkson uses to evaluate Satisfactory Academic Progress at the conclusion of each term. (Call your SAS Representative at 315-268-6451 for all questions regarding your financial aid status). SAP Regulations: http://www.clarkson.edu/sas/financial/regulations/sap_1213.html

PACE and GPA Chart

PACE Chart

Cumulative Attempted Credit Hours / PACE – Minimum required percentage of earned credit hours divided by attempted credit hours
0-18 / 50%
19-36 / 50%
37-54 / 67%
55-72 / 67%
73-180 / 67%

GPA Chart

End of Semester / Minimum GPA – Required at the end of Semester
First / 1.00
Second / 1.40
Third / 1.75
Fourth-Twelfth / 2.00

Rev 12/2015 js