CUYAMACA COLLEGE
Instructor Reinstatement Form
PRINT IN INK
This form should only be submitted for students who were officially enrolled in your class (as shown on your Class Roster or
your Add/Drop Activity List) and then dropped. The drop could have been initiated by the student or by the instructor; however,
the student’s attendance should be continuous. BOTH SIGNATURES ARE REQUIRED!
Submit the form to Admissions and Records as soon as possible.
Semester: Spring 20 ______
Summer 20 ______
Fall 20 ______
Instructor’s Name: _____________________________________
Subject & Number _____________________
Section Number: ____________________________
Please Print
X_________________________________________________________________
Instructor’s Signature (signature verifies continuous attendance in class)
Student’s Name: ________________________________________
Date _________________________
I.D. Number: ____________________________
Please Print
X_________________________________________________________________
Student’s Signature (signature verifies desire to be reinstated into class)
Date Received _____________ Received By _________
Date _________________________
Date Processed ____________ Processed By _________