Readmission Request: Disciplinary Suspension

Background Information

This request for consideration must be completed by the student. No other individual may act on the student's behalf.

Your Full Name:

Your Phone Number:

Your Non-CSU Email Address:

Email address must be of a valid format.

Your Current Address:

I request readmission for(Required):

This field is required.

Date of Request(Required):

This field is required.

Involved Parties

Student Name

Select Gender

Student ID Number

DOB (YYYY-MM-DD)

Student Phone number

CSU Email address

Permanent Address

Questions

Provide description of the events which led to your suspension from the University.(Required) This field is required.

Discuss your current feelings about the reason for your suspension and how personal change has occurred during your time away from the University.(Required) This field is required.

Provide a description of your activities while away from the University, which depending on your unique situation may include: counseling, therapy, recovery, employment, volunteer work, etc.(Required) This field is required.

I understand that I MAY be asked to submit a letter from a licensed mental health counselor, psychologist, or psychiatrist indicating a) situational understanding of the reasons for my suspension, b) describing my relationship with them during the time of my suspension, and c) a recommendation to the University. I Understand this letter(s) must be signed and on the professional letterhead. Furthermore, I understand that the University reserves the right to administer assessment tools they deem appropriate to protect the physical and/or emotional safety of the campus community. I understand that I should contact the Assistant Dean of Students, Dana Larkin at 706-507-8333 to discuss the specific documentation and assessment required for my situation.(Required)

I Understand

You must make at least one selection.

I understand that I MUST attach a signed letter of support from a non-family member indicating: a) situational understanding of the reasons for my suspension, b) describing my relationship with them during the time of my suspension, and c) a recommendation to the University.(Required)

I Understand

You must make at least one selection.

Have you been enrolled in another college or university during your time of withdrawal or suspension?(Required)

Yes No

This field is required.

Have you ever been convicted of any criminal offense other than a traffic violation, or do you have charges pending?(Required)

Yes No

This field is required.

If you answered "Yes" to the previous question, please explain. This field is required.

I understand that being readmitted through this process does not approve or otherwise qualify me to receive financial aid, student loans, VA benefits, or other forms of financial assistance. Furthermore, I understand it is my responsibility to contact the appropriate office to apply for or verify such funds.(Required)

I Understand

You must make at least one selection.

I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto, may subject me to disciplinary sanctions, in accordance with the Columbus State University Student Handbook, which may include immediate dismissal from the institution. Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.(Required)

I Understand

You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission