Reinstatement Appeal Form

By submitting the Reinstatement Appeal Form, you are acknowledging that you will be charged a non-refundable $250 post census registration activity fee to your student account and a possible $25 late fee per session.

If you are an Accelerated Online Student, please contact your academic advisor within your major. Please do not use this form.

Within 3 to 5 business days after the appeal form is received, the Reinstatement Appeal Committee will issue a decision on the appeal to your UTA email address.

If the appeal is approved, tuition and fees will be due immediately. For questions regarding your tuition and fees, please contact Student Accounts at studentaccounts@tn.uta.edu

Student Id number:
Student Name Student Name First Middle Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
UTA Email Address
Phone Phone - ### - ### ####
Term for which reinstatement is requested

Term for which reinstatement is requested Not Currently Accepting Reinstatement Appeals
Year for which reinstatement is requested
Classification

Classification Freshman Senior Junior Degreed Undergraduate Sophomore Graduate (Masters/PhD)
In the space below, please explain why you are requesting that an exception be granted to the University's reinstatement policy.