UNDERGRADUATE
 GRADUATE
Office of Student Assistance
APPLICATION FOR
RESUMPTION OF STUDY
________________________________________
STUDENT ID NUMBER
_________________________________________________________________________________________________
LAST NAME
FIRST NAME
MIDDLE
(Can not be changed with this form; official documentation required.)
□ Address
If this is a new address/phone #, please indicate what you would like to be updated on your record
□ Telephone
__________________________________________________________________________________________________________________
STREET ADDRESS / P.O. BOX
CITY
STATE
ZIP
__________________________________________________________________________________________________________________
DAY TELEPHONE NUMBER
EVENING TELEPHONE NUMBER
MOBILE/CELL NUMBER
__________________________________________________________________________________________________________________
EMERGENCY CONTACT
DATE OF BIRTH:
_____ /_____/_____
Month Day
Year
EMERGENCY CONTACT NUMBER
EMERGENCY RELATIONSHIP
ETHNIC BACKGROUND:
SEX:
MARITAL STATUS
 1 (Black Non-Hispanic)  4 (American Indian / Alaskan-Native)
 2 (Asian or Pacific Islander)  5 (White Non-Hispanic)
 3 (Hispanic)
 6 (Other) ___________
 Male
 Female
 Single
 Married
YES  NO
IF YES, YOU MAY NOT RESUME STUDY UNTIL ALL OFFICIAL TRANSCRIPTS ARE RECEIVED. PLEASE INDICATE BELOW ALL SCHOOLS
YOU HAVE ATTENDED AND HAVE THE SCHOOL FORWARD AN OFFICIAL TRANSCRIPT TO THE OFFICE OF STUDENT ASSISTANCE.
DATES OF ATTENDANCE
NAME OF COLLEGE(S)
HAVE YOU ATTENDED ANY OTHER COLLEGE OR INSTITUTION SINCE YOUR LAST TERM OF ATTENDANCE AT PACE?
_____________________________________________________
________________________________________________
_____________________________________________________
________________________________________________
CITIZEN STATUS:
IF NOT A U.S. CITIZEN, PLEASE INDICATE BELOW
COUNTRY OF BIRTH___________________________________________
COUNTRY OF
CITIZENSHIP___________________________________
VISA TYPE_____________________________________________________
LAST TERM ATTENDANCE AT PACE (Year)
_______
 Fall (70)
 Spring (20)
 Summer 1 (40)
 Summer 2 (50)
A MINIMUM 2.00 OVERALL GPA IS REQUIRED (Undergraduate)
TERM YOU ARE APPLYING (Year) 20______
 Fall (70)
 Spring (20)
 Summer 1 (40)
 Summer 2 (50)
A MINIMUM 3.00 OVERALL GPA IS REQUIRED (Graduate)
I WAS PREVIOUSLY ENROLLED IN THE FOLLOWING:
Please check appropriate boxes
*LEVEL
 01 (Undergraduate)
 02 (Graduate)
*HOME CAMPUS:
1 (New York)
 a) Downtown
 b) Midtown
 2 (Pleasantville)
 3 (White Plains)
*STATUS:
 Matriculated
 Non Matriculated (Undergrad)
 NDS (Graduate)
*DEGREE:________________________________________________ *MAJOR:________________________________________
*NOTE: THIS INFORMATION CAN NOT BE CHANGED ON THIS FORM. APPROPRIATE FORMS MUST BE FILED AT THE OSA OFFICE
_____________________________________________________________________
Student’s Signature
Page 1 of 2
Date
Rev. 03/08
RESUMPTION OF STUDY ACTION FORM
FOR DEAN'S USE:
Undergraduate (Only)
 AD (ACADEMIC DISMISSAL)
 P1 (ACADEMIC PROBATION -1ST)
 P2 (ACADEMIC PROBATION - 2ND)
 P3 (ACADEMIC PROBATION - FINAL)
Graduate (Only)
 P5 (PROBATION REMOVED)
 R1 REINSTATED
 R2 REINSTATED WITH CONDITIONS
 AD (ACADEMIC DISMISSAL)
 R1 REINSTATED
 R2 REINSTATED WITH CONDITIONS
COMMENTS / CONDITIONS:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
______________________________________________________________
Dean’s Signature
Date
FOR OFFICE USE ONLY:
OFFICIAL TRANSCRIPT RECEIVED:
□ YES
TOTAL __________
□ NO
SOAHOLD
OSA & HOLD CLEARANCE: ______________________
SHATERM
OVERALL GPA: ___________
SHADEGR
GRAD DATE:________________
□ NOT APPLICABLE
SGASTDN
(Learner Tab)
NEW TERM: ___________
STUDENT STATUS RA
STUDENT TYPE R
SITE: _________________
(Curriculum Tab)
CATALOG TERM: __________
PROG: __________
CAMP:___________
DEGR: ___________
ADMS TERM: __________
MATR TERM: _________
FIELD OF STUDY: ____________
DEPT: ___________
(Field of Study Tab) CATALOG TERM: __________
NOTE:
COLL:_________
IF THERE ARE ANY STIPULATIONS PLACED ON THE STUDENT'S REGISTRATION PLEASE INDICATE ON BANNER
BEFORE PROCEEDING TO REGISTRATION ACTION FORM.
SHAINST
ACAD STAT: _____________
TGACOMC
□ CONFIRMATION LETTER SENT
____________________________________________________
OSA ADVISOR
DATE
Page 2 of 2
Rev. 03/08